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D’Cruz N, De Vleeschhauwer J, Putzolu M, Nackaerts E, Gilat M, Nieuwboer A. Sensorimotor Network Segregation Predicts Long-Term Learning of Writing Skills in Parkinson's Disease. Brain Sci 2024; 14:376. [PMID: 38672025 PMCID: PMC11047850 DOI: 10.3390/brainsci14040376] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2024] [Revised: 04/07/2024] [Accepted: 04/09/2024] [Indexed: 04/28/2024] Open
Abstract
The prediction of motor learning in Parkinson's disease (PD) is vastly understudied. Here, we investigated which clinical and neural factors predict better long-term gains after an intensive 6-week motor learning program to ameliorate micrographia. We computed a composite score of learning through principal component analysis, reflecting better writing accuracy on a tablet in single and dual task conditions. Three endpoints were studied-acquisition (pre- to post-training), retention (post-training to 6-week follow-up), and overall learning (acquisition plus retention). Baseline writing, clinical characteristics, as well as resting-state network segregation were used as predictors. We included 28 patients with PD (13 freezers and 15 non-freezers), with an average disease duration of 7 (±3.9) years. We found that worse baseline writing accuracy predicted larger gains for acquisition and overall learning. After correcting for baseline writing accuracy, we found female sex to predict better acquisition, and shorter disease duration to help retention. Additionally, absence of FOG, less severe motor symptoms, female sex, better unimanual dexterity, and better sensorimotor network segregation impacted overall learning positively. Importantly, three factors were retained in a multivariable model predicting overall learning, namely baseline accuracy, female sex, and sensorimotor network segregation. Besides the room to improve and female sex, sensorimotor network segregation seems to be a valuable measure to predict long-term motor learning potential in PD.
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Affiliation(s)
- Nicholas D’Cruz
- Research Group for Neurorehabilitation (eNRGy), Department of Rehabilitation Sciences, KU Leuven, Tervuursevest 101, Box 1500, B-3001 Leuven, Belgium; (N.D.); (J.D.V.); (E.N.); (M.G.)
| | - Joni De Vleeschhauwer
- Research Group for Neurorehabilitation (eNRGy), Department of Rehabilitation Sciences, KU Leuven, Tervuursevest 101, Box 1500, B-3001 Leuven, Belgium; (N.D.); (J.D.V.); (E.N.); (M.G.)
| | - Martina Putzolu
- Department of Experimental Medicine (DIMES), Section of Human Physiology, University of Genoa, 16132 Genoa, Italy;
| | - Evelien Nackaerts
- Research Group for Neurorehabilitation (eNRGy), Department of Rehabilitation Sciences, KU Leuven, Tervuursevest 101, Box 1500, B-3001 Leuven, Belgium; (N.D.); (J.D.V.); (E.N.); (M.G.)
| | - Moran Gilat
- Research Group for Neurorehabilitation (eNRGy), Department of Rehabilitation Sciences, KU Leuven, Tervuursevest 101, Box 1500, B-3001 Leuven, Belgium; (N.D.); (J.D.V.); (E.N.); (M.G.)
| | - Alice Nieuwboer
- Research Group for Neurorehabilitation (eNRGy), Department of Rehabilitation Sciences, KU Leuven, Tervuursevest 101, Box 1500, B-3001 Leuven, Belgium; (N.D.); (J.D.V.); (E.N.); (M.G.)
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Yang PK, Filtjens B, Ginis P, Goris M, Nieuwboer A, Gilat M, Slaets P, Vanrumste B. Freezing of gait assessment with inertial measurement units and deep learning: effect of tasks, medication states, and stops. J Neuroeng Rehabil 2024; 21:24. [PMID: 38350964 PMCID: PMC10865632 DOI: 10.1186/s12984-024-01320-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Accepted: 01/30/2024] [Indexed: 02/15/2024] Open
Abstract
BACKGROUND Freezing of gait (FOG) is an episodic and highly disabling symptom of Parkinson's Disease (PD). Traditionally, FOG assessment relies on time-consuming visual inspection of camera footage. Therefore, previous studies have proposed portable and automated solutions to annotate FOG. However, automated FOG assessment is challenging due to gait variability caused by medication effects and varying FOG-provoking tasks. Moreover, whether automated approaches can differentiate FOG from typical everyday movements, such as volitional stops, remains to be determined. To address these questions, we evaluated an automated FOG assessment model with deep learning (DL) based on inertial measurement units (IMUs). We assessed its performance trained on all standardized FOG-provoking tasks and medication states, as well as on specific tasks and medication states. Furthermore, we examined the effect of adding stopping periods on FOG detection performance. METHODS Twelve PD patients with self-reported FOG (mean age 69.33 ± 6.02 years) completed a FOG-provoking protocol, including timed-up-and-go and 360-degree turning-in-place tasks in On/Off dopaminergic medication states with/without volitional stopping. IMUs were attached to the pelvis and both sides of the tibia and talus. A temporal convolutional network (TCN) was used to detect FOG episodes. FOG severity was quantified by the percentage of time frozen (%TF) and the number of freezing episodes (#FOG). The agreement between the model-generated outcomes and the gold standard experts' video annotation was assessed by the intra-class correlation coefficient (ICC). RESULTS For FOG assessment in trials without stopping, the agreement of our model was strong (ICC (%TF) = 0.92 [0.68, 0.98]; ICC(#FOG) = 0.95 [0.72, 0.99]). Models trained on a specific FOG-provoking task could not generalize to unseen tasks, while models trained on a specific medication state could generalize to unseen states. For assessment in trials with stopping, the agreement of our model was moderately strong (ICC (%TF) = 0.95 [0.73, 0.99]; ICC (#FOG) = 0.79 [0.46, 0.94]), but only when stopping was included in the training data. CONCLUSION A TCN trained on IMU signals allows valid FOG assessment in trials with/without stops containing different medication states and FOG-provoking tasks. These results are encouraging and enable future work investigating automated FOG assessment during everyday life.
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Affiliation(s)
- Po-Kai Yang
- eMedia Research Lab/STADIUS, Department of Electrical Engineering (ESAT), KU Leuven, Andreas Vesaliusstraat 13, 3000, Leuven, Belgium.
- Intelligent Mobile Platforms Research Group, Department of Mechanical Engineering, KU Leuven, Andreas Vesaliusstraat 13, 3000, Leuven, Belgium.
| | - Benjamin Filtjens
- eMedia Research Lab/STADIUS, Department of Electrical Engineering (ESAT), KU Leuven, Andreas Vesaliusstraat 13, 3000, Leuven, Belgium
- Intelligent Mobile Platforms Research Group, Department of Mechanical Engineering, KU Leuven, Andreas Vesaliusstraat 13, 3000, Leuven, Belgium
| | - Pieter Ginis
- Research Group for Neurorehabilitation (eNRGy), Department of Rehabilitation Sciences, KU Leuven, Tervuursevest 101, 3001, Heverlee, Belgium
| | - Maaike Goris
- Research Group for Neurorehabilitation (eNRGy), Department of Rehabilitation Sciences, KU Leuven, Tervuursevest 101, 3001, Heverlee, Belgium
| | - Alice Nieuwboer
- Research Group for Neurorehabilitation (eNRGy), Department of Rehabilitation Sciences, KU Leuven, Tervuursevest 101, 3001, Heverlee, Belgium
| | - Moran Gilat
- Research Group for Neurorehabilitation (eNRGy), Department of Rehabilitation Sciences, KU Leuven, Tervuursevest 101, 3001, Heverlee, Belgium
| | - Peter Slaets
- Intelligent Mobile Platforms Research Group, Department of Mechanical Engineering, KU Leuven, Andreas Vesaliusstraat 13, 3000, Leuven, Belgium
| | - Bart Vanrumste
- eMedia Research Lab/STADIUS, Department of Electrical Engineering (ESAT), KU Leuven, Andreas Vesaliusstraat 13, 3000, Leuven, Belgium
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Quek DYL, Taylor N, Gilat M, Lewis SJG, Ehgoetz Martens KA. Effect of dopamine on limbic network connectivity at rest in Parkinson's disease patients with freezing of gait. Transl Neurosci 2024; 15:20220336. [PMID: 38708096 PMCID: PMC11066616 DOI: 10.1515/tnsci-2022-0336] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2023] [Revised: 02/12/2024] [Accepted: 02/13/2024] [Indexed: 05/07/2024] Open
Abstract
Background Freezing of gait (FOG) in Parkinson's disease (PD) has a poorly understood pathophysiology, which hinders treatment development. Recent work showed a dysfunctional fronto-striato-limbic circuitry at rest in PD freezers compared to non-freezers in the dopamine "OFF" state. While other studies found that dopaminergic replacement therapy alters functional brain organization in PD, the specific effect of dopamine medication on fronto-striato-limbic functional connectivity in freezers remains unclear. Objective To evaluate how dopamine therapy alters resting state functional connectivity (rsFC) of the fronto-striato-limbic circuitry in PD freezers, and whether the degree of connectivity change is related to freezing severity and anxiety. Methods Twenty-three PD FOG patients underwent MRI at rest (rsfMRI) in their clinically defined "OFF" and "ON" dopaminergic medication states. A seed-to-seed based analysis was performed between a priori defined limbic circuitry ROIs. Functional connectivity was compared between OFF and ON states. A secondary correlation analyses evaluated the relationship between Hospital Anxiety and Depression Scale (HADS)-Anxiety) and FOG Questionnaire with changes in rsFC from OFF to ON. Results PD freezers' OFF compared to ON showed increased functional coupling between the right hippocampus and right caudate nucleus, and between the left putamen and left posterior parietal cortex (PPC). A negative association was found between HADS-Anxiety and the rsFC change from OFF to ON between the left amygdala and left prefrontal cortex, and left putamen and left PPC. Conclusion These findings suggest that dopaminergic medication partially modulates the frontoparietal-limbic-striatal circuitry in PD freezers, and that the influence of medication on the amygdala, may be related to clinical anxiety in freezer.
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Affiliation(s)
- Dione Y. L. Quek
- Parkinson’s Disease Research Clinic, Brain and Mind Centre, University of Sydney, Sydney, Australia
| | - Natasha Taylor
- Parkinson’s Disease Research Clinic, Brain and Mind Centre, University of Sydney, Sydney, Australia
| | - Moran Gilat
- Neurorehabilitation Research Group (eNRGy), Department of Rehabilitation Sciences, KU Leuven, Leuven, Belgium
| | - Simon J. G. Lewis
- Parkinson’s Disease Research Clinic, Brain and Mind Centre, University of Sydney, Sydney, Australia
| | - Kaylena A. Ehgoetz Martens
- Parkinson’s Disease Research Clinic, Brain and Mind Centre, University of Sydney, Sydney, Australia
- Department of Kinesiology and Health Sciences, University of Waterloo, 200 University Avenue West, WaterlooON, N2L3G1Canada
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Vandendoorent B, Nackaerts E, Zoetewei D, Hulzinga F, Gilat M, Orban de Xivry JJ, Nieuwboer A. Effect of transcranial direct current stimulation on learning in older adults with and without Parkinson's disease: A systematic review with meta-analysis. Brain Cogn 2023; 171:106073. [PMID: 37611344 DOI: 10.1016/j.bandc.2023.106073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2023] [Revised: 06/26/2023] [Accepted: 07/31/2023] [Indexed: 08/25/2023]
Abstract
Older adults with and without Parkinson's disease show impaired retention after training of motor or cognitive skills. This systematic review with meta-analysis aims to investigate whether adding transcranial direct current stimulation (tDCS) to motor or cognitive training versus placebo boosts motor sequence and working memory training. The effects of interest were estimated between three time points, i.e. pre-training, post-training and follow-up. This review was conducted according to the PRISMA guidelines (PROSPERO: CRD42022348885). Electronic databases were searched from conception to March 2023. Following initial screening, 24 studies were eligible for inclusion in the qualitative synthesis and 20 could be included in the meta-analysis, of which 5 studies concerned motor sequence learning (total n = 186) and 15 working memory training (total n = 650). Results were pooled using an inverse variance random effects meta-analysis. The findings showed no statistically significant additional effects of tDCS over placebo on motor sequence learning outcomes. However, there was a strong trend showing that tDCS boosted working memory training, although methodological limitations and some heterogeneity were also apparent. In conclusion, the present findings do not support wide implementation of tDCS as an add-on to motor sequence training at the moment, but the promising results on cognitive training warrant further investigations.
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Affiliation(s)
- Britt Vandendoorent
- Neuromotor Rehabilitation Research Group, Department of Rehabilitation Sciences, KU Leuven, Leuven, Belgium.
| | - Evelien Nackaerts
- Neuromotor Rehabilitation Research Group, Department of Rehabilitation Sciences, KU Leuven, Leuven, Belgium
| | - Demi Zoetewei
- Neuromotor Rehabilitation Research Group, Department of Rehabilitation Sciences, KU Leuven, Leuven, Belgium
| | - Femke Hulzinga
- Neuromotor Rehabilitation Research Group, Department of Rehabilitation Sciences, KU Leuven, Leuven, Belgium
| | - Moran Gilat
- Neuromotor Rehabilitation Research Group, Department of Rehabilitation Sciences, KU Leuven, Leuven, Belgium
| | - Jean-Jacques Orban de Xivry
- Movement Control and Neuroplasticity Research Group, Department of Movement Sciences, KU Leuven, Leuven, Belgium
| | - Alice Nieuwboer
- Neuromotor Rehabilitation Research Group, Department of Rehabilitation Sciences, KU Leuven, Leuven, Belgium
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Georgiades MJ, Shine JM, Gilat M, McMaster J, Owler B, Mahant N, Lewis SJ. Subthalamic Nucleus Activity during Cognitive Load and Gait Dysfunction in Parkinson's Disease. Mov Disord 2023; 38:1549-1554. [PMID: 37226972 PMCID: PMC10946988 DOI: 10.1002/mds.29455] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2021] [Revised: 05/01/2023] [Accepted: 05/08/2023] [Indexed: 05/26/2023] Open
Abstract
BACKGROUND Gait freezing is a common, disabling symptom of Parkinson's disease characterized by sudden motor arrest during walking. Adaptive deep brain stimulation devices that detect freezing and deliver real-time, symptom-specific stimulation are a potential treatment strategy. Real-time alterations in subthalamic nucleus firing patterns have been demonstrated with lower limb freezing, however, whether similar abnormal signatures occur with freezing provoked by cognitive load, is unknown. METHODS We obtained subthalamic nucleus microelectrode recordings from eight Parkinson's disease patients performing a validated virtual reality gait task, requiring responses to on-screen cognitive cues while maintaining motor output. RESULTS Signal analysis during 15 trials containing freezing or significant motor output slowing precipitated by dual-tasking demonstrated reduced θ frequency (3-8 Hz) firing compared to 18 unaffected trials. CONCLUSIONS These preliminary results reveal a potential neurobiological basis for the interplay between cognitive factors and gait disturbances including freezing in Parkinson's disease, informing development of adaptive deep brain stimulation protocols. © 2023 The Authors. Movement Disorders published by Wiley Periodicals LLC on behalf of International Parkinson and Movement Disorder Society.
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Affiliation(s)
- Matthew J. Georgiades
- ForeFront Parkinson's Disease Research Clinic, Brain and Mind CentreUniversity of SydneySydneyNew South WalesAustralia
- Sydney Medical SchoolThe University of SydneySydneyNew South WalesAustralia
| | - James M. Shine
- ForeFront Parkinson's Disease Research Clinic, Brain and Mind CentreUniversity of SydneySydneyNew South WalesAustralia
- Sydney Medical SchoolThe University of SydneySydneyNew South WalesAustralia
| | - Moran Gilat
- ForeFront Parkinson's Disease Research Clinic, Brain and Mind CentreUniversity of SydneySydneyNew South WalesAustralia
- KU Leuven, Department of Rehabilitation SciencesNeurorehabilitation Research Group (eNRGy)Belgium
| | | | - Brian Owler
- Sydney Medical SchoolThe University of SydneySydneyNew South WalesAustralia
- Westmead Private HospitalSydneyNew South WalesAustralia
| | - Neil Mahant
- Sydney Medical SchoolThe University of SydneySydneyNew South WalesAustralia
- Westmead Private HospitalSydneyNew South WalesAustralia
| | - Simon J.G. Lewis
- ForeFront Parkinson's Disease Research Clinic, Brain and Mind CentreUniversity of SydneySydneyNew South WalesAustralia
- Sydney Medical SchoolThe University of SydneySydneyNew South WalesAustralia
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Dijkstra BW, Gilat M, D'Cruz N, Zoetewei D, Nieuwboer A. Neural underpinnings of freezing-related dynamic balance control in people with Parkinson's disease. Parkinsonism Relat Disord 2023; 112:105444. [PMID: 37257264 DOI: 10.1016/j.parkreldis.2023.105444] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2023] [Revised: 04/08/2023] [Accepted: 05/11/2023] [Indexed: 06/02/2023]
Abstract
INTRODUCTION People with Parkinson's disease (PD) with freezing of gait (FOG; freezers) show impaired dynamic balance and experience falls more frequently compared to those without (non-freezers). Here, we explore the neural underpinnings of these freezing-related balance problems. METHODS 12 freezers, 16 non-freezers and 14 controls performed a dynamic balance task in the lab. The next day, the same task was investigated in the MRI-scanner through motor imagery (MI). A visual imagery (VI) control task was also performed. Imagery engagement was determined by comparing the performance times between the dynamic balance task, and its MI- and VI-variants. Balance-related brain activations in regions of interest were contrasted between groups based on an MI > rest versus VI > rest contrast. RESULTS Freezers and non-freezers were matched for age, cognition and disease severity. Similar performance times between the balance control task and the MI-conditions revealed excellent imagery engagement. Compared to non-freezers, freezers showed decreased activation in regions of interest located in the left mesencephalic locomotor region (MLR; p = 0.006), right anterior cerebellum (p = 0.017) and cerebellar vermis (p < 0.001). Intriguingly, non-freezers showed higher activations in the cerebellar vermis than controls (p = 0.010). CONCLUSION Overall, we showed that decreased activation in the left MLR, and cerebellar regions in freezers relative to non-freezers could explain why dynamic balance is more affected in freezers. As non-freezers displayed increased cerebellar vermis activation compared to controls, it is possible that freezers show an inability to recruit sufficient compensatory cerebellar activity for effective dynamic balance control.
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Affiliation(s)
- Bauke W Dijkstra
- KU Leuven, Department of Rehabilitation Sciences, Neurorehabilitation Research Group (eNRGy), Leuven, Belgium
| | - Moran Gilat
- KU Leuven, Department of Rehabilitation Sciences, Neurorehabilitation Research Group (eNRGy), Leuven, Belgium.
| | - Nicholas D'Cruz
- KU Leuven, Department of Rehabilitation Sciences, Neurorehabilitation Research Group (eNRGy), Leuven, Belgium
| | - Demi Zoetewei
- KU Leuven, Department of Rehabilitation Sciences, Neurorehabilitation Research Group (eNRGy), Leuven, Belgium
| | - Alice Nieuwboer
- KU Leuven, Department of Rehabilitation Sciences, Neurorehabilitation Research Group (eNRGy), Leuven, Belgium
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Ginis P, Goris M, De Groef A, Blondeel A, Gilat M, Demeyer H, Troosters T, Nieuwboer A. Validation of Commercial Activity Trackers in Everyday Life of People with Parkinson's Disease. Sensors (Basel) 2023; 23:4156. [PMID: 37112496 PMCID: PMC10144957 DOI: 10.3390/s23084156] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/24/2022] [Revised: 04/07/2023] [Accepted: 04/18/2023] [Indexed: 06/19/2023]
Abstract
Maintaining physical activity is an important clinical goal for people with Parkinson's disease (PwPD). We investigated the validity of two commercial activity trackers (ATs) to measure daily step counts. We compared a wrist- and a hip-worn commercial AT against the research-grade Dynaport Movemonitor (DAM) during 14 days of daily use. Criterion validity was assessed in 28 PwPD and 30 healthy controls (HCs) by a 2 × 3 ANOVA and intraclass correlation coefficients (ICC2,1). The ability to measure daily step fluctuations compared to the DAM was studied by a 2 × 3 ANOVA and Kendall correlations. We also explored compliance and user-friendliness. Both the ATs and the DAM measured significantly fewer steps/day in PwPD compared to HCs (p < 0.01). Step counts derived from the ATs showed good to excellent agreement with the DAM in both groups (ICC2,1 > 0.83). Daily fluctuations were detected adequately by the ATs, showing moderate associations with DAM-rankings. While compliance was high overall, 22% of PwPD were disinclined to use the ATs after the study. Overall, we conclude that the ATs had sufficient agreement with the DAM for the purpose of promoting physical activity in mildly affected PwPD. However, further validation is needed before clinical use can be widely recommended.
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Affiliation(s)
- Pieter Ginis
- KU Leuven, Department of Rehabilitation Sciences, Neurorehabilitation Research Group (eNRGy), 3000 Leuven, Belgium
| | - Maaike Goris
- KU Leuven, Department of Rehabilitation Sciences, Neurorehabilitation Research Group (eNRGy), 3000 Leuven, Belgium
| | - An De Groef
- KU Leuven, Department of Rehabilitation Sciences, Research Group for Rehabilitation in Internal Disorders (GRID), 3000 Leuven, Belgium
- MOVANT Research Group, Department of Rehabilitation Sciences, University of Antwerp, 2000 Antwerp, Belgium
| | - Astrid Blondeel
- KU Leuven, Department of Rehabilitation Sciences, Research Group for Rehabilitation in Internal Disorders (GRID), 3000 Leuven, Belgium
- Pulmonary Rehabilitation, Respiratory Department, University Hospitals Gasthuisberg, 3000 Leuven, Belgium
| | - Moran Gilat
- KU Leuven, Department of Rehabilitation Sciences, Neurorehabilitation Research Group (eNRGy), 3000 Leuven, Belgium
| | - Heleen Demeyer
- KU Leuven, Department of Rehabilitation Sciences, Research Group for Rehabilitation in Internal Disorders (GRID), 3000 Leuven, Belgium
- Department of Rehabilitation Sciences, Ghent University, 9000 Ghent, Belgium
| | - Thierry Troosters
- KU Leuven, Department of Rehabilitation Sciences, Research Group for Rehabilitation in Internal Disorders (GRID), 3000 Leuven, Belgium
- Pulmonary Rehabilitation, Respiratory Department, University Hospitals Gasthuisberg, 3000 Leuven, Belgium
| | - Alice Nieuwboer
- KU Leuven, Department of Rehabilitation Sciences, Neurorehabilitation Research Group (eNRGy), 3000 Leuven, Belgium
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de Rond V, Gilat M, D’Cruz N, Hulzinga F, Orban de Xivry JJ, Nieuwboer A. Test-retest reliability of functional near-infrared spectroscopy during a finger-tapping and postural task in healthy older adults. Neurophotonics 2023; 10:025010. [PMID: 37250101 PMCID: PMC10218660 DOI: 10.1117/1.nph.10.2.025010] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/10/2022] [Revised: 03/30/2023] [Accepted: 04/14/2023] [Indexed: 05/31/2023]
Abstract
Significance Functional near-infrared spectroscopy (fNIRS) is increasingly employed in studies requiring repeated measurements, yet test-retest reliability is largely unknown. Aim To investigate test-retest reliability during a postural and a finger-tapping task with and without cap-removal. Approach Twenty healthy older adults performed a postural and a finger-tapping task. The tasks were repeated twice in one session and once the next day. A portable fNIRS system measured cortical hemodynamics (HbO2) in five regions of interest for the postural task and in the hand motor region for finger-tapping. Results Test-retest reliability without cap-removal was excellent for the prefrontal cortex (PFC), the premotor cortex (PMC) and the somatosensory cortex (SSC) (intraclass correlation coefficient (ICC)≥0.78), and fair for the frontal eye fields (FEF) and the supplementary motor area (SMA) (ICC≥0.48). After cap-removal, reliability reduced for PFC and SSC (ICC≥0.50), became poor for SMA (ICC=0.01) and PMC (ICC=0.00) and remained good for FEF (ICC=0.64). Similarly, good reliability (ICC=0.66) was apparent for the hand motor region without cap-removal, which deteriorated after cap-removal (ICC=0.38). Conclusions Test-retest reliability of fNIRS measurements during two separate motor tasks in healthy older adults was fair to excellent when the cap remained in place. However, removing the fNIRS cap between measurements compromised reliability.
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Affiliation(s)
- Veerle de Rond
- KU Leuven, Department of Rehabilitation Sciences, Neurorehabilitation Research Group, Leuven, Belgium
| | - Moran Gilat
- KU Leuven, Department of Rehabilitation Sciences, Neurorehabilitation Research Group, Leuven, Belgium
- Leuven Brain Institute, Leuven, Belgium
| | - Nicholas D’Cruz
- KU Leuven, Department of Rehabilitation Sciences, Neurorehabilitation Research Group, Leuven, Belgium
- KU Leuven, Department of Kinesiology, Motor Control and Neuroplasticity Research Group, Leuven, Belgium
| | - Femke Hulzinga
- KU Leuven, Department of Rehabilitation Sciences, Neurorehabilitation Research Group, Leuven, Belgium
| | - Jean-Jacques Orban de Xivry
- Leuven Brain Institute, Leuven, Belgium
- KU Leuven, Department of Kinesiology, Motor Control and Neuroplasticity Research Group, Leuven, Belgium
| | - Alice Nieuwboer
- KU Leuven, Department of Rehabilitation Sciences, Neurorehabilitation Research Group, Leuven, Belgium
- Leuven Brain Institute, Leuven, Belgium
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Vandendoorent B, Broeder S, Nackaerts E, Orban de Xivry JJ, Nieuwboer A, Gilat M, Hermans P. No supplementary effect of one session of transcranial direct current stimulation during motor sequence learning on 24-hour retention in healthy older adults. Brain Stimul 2023. [DOI: 10.1016/j.brs.2023.01.818] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/17/2023] Open
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Gilat M, Marshall NS, Testelmans D, Buyse B, Lewis SJG. A critical review of the pharmacological treatment of REM sleep behavior disorder in adults: time for more and larger randomized placebo-controlled trials. J Neurol 2022; 269:125-148. [PMID: 33410930 PMCID: PMC8739295 DOI: 10.1007/s00415-020-10353-0] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2020] [Revised: 11/25/2020] [Accepted: 12/04/2020] [Indexed: 12/24/2022]
Abstract
Rapid Eye Movement sleep behavior disorder (RBD) is a parasomnia causing sufferers to physically act out their dreams. These behaviors can disrupt sleep and sometimes lead to injuries in patients and their bed-partners. Clonazepam and melatonin are the first-line pharmacological treatment options for RBD based on direct uncontrolled clinical observations and very limited double-blind placebo-controlled trials. Given the risk for adverse outcomes, especially in older adults, it is of great importance to assess the existing level of evidence for the use of these treatments. In this update, we therefore critically review the clinical and scientific evidence on the pharmacological management of RBD in people aged over 50. We focus on the first-line treatments, and provide an overview of all other alternative pharmacological agents trialed for RBD we could locate as supplementary materials. By amalgamating all clinical observations, our update shows that 66.7% of 1,026 RBD patients reported improvements from clonazepam and 32.9% of 137 RBD patients reported improvements from melatonin treatment on various outcome measures in published accounts. Recently, however, three relatively small randomized placebo-controlled trials did not find these agents to be superior to placebo. Given clonazepam and melatonin are clinically assumed to majorly modify or eliminate RBD in nearly all patients-there is an urgent need to test whether this magnitude of treatment effect remains intact in larger placebo-controlled trials.
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Affiliation(s)
- Moran Gilat
- Neurorehabilitation Research Group (eNRGy), Department of Rehabilitation Sciences, KU Leuven, Tervuursevest 101, box 1501, 3001, Leuven, Belgium.
| | - Nathaniel S. Marshall
- grid.1013.30000 0004 1936 834XWoolcock Institute of Medical Research, University of Sydney, Sydney, Australia
| | - Dries Testelmans
- grid.5596.f0000 0001 0668 7884Centre for Sleep and Wake Disorders (LUCS), Department of Pneumology, Leuven University, UZ Leuven, Leuven, Belgium
| | - Bertien Buyse
- grid.5596.f0000 0001 0668 7884Centre for Sleep and Wake Disorders (LUCS), Department of Pneumology, Leuven University, UZ Leuven, Leuven, Belgium
| | - Simon J. G. Lewis
- grid.1013.30000 0004 1936 834XForefront Parkinson’s Disease Research Clinic, Brain and Mind Centre, School of Medical Sciences, University of Sydney, Sydney, Australia
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11
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Jia XZ, Zhao N, Dong HM, Sun JW, Barton M, Burciu R, Carrière N, Cerasa A, Chen BY, Chen J, Coombes S, Defebvre L, Delmaire C, Dujardin K, Esposito F, Fan GG, Di Nardo F, Feng YX, Fling BW, Garg S, Gilat M, Gorges M, Ho SL, Horak FB, Hu X, Hu XF, Huang B, Huang PY, Jia ZJ, Jones C, Kassubek J, Krajcovicova L, Kurani A, Li J, Li Q, Liu AP, Liu B, Liu H, Liu WG, Lopes R, Lou YT, Luo W, Madhyastha T, Mao NN, McAlonan G, McKeown MJ, Pang S, Quattrone A, Rektorova I, Sarica A, Shang HF, Shine JM, Shukla P, Slavicek T, Song XP, Tedeschi G, Tessitore A, Vaillancourt D, Wang J, Wang J, Jane Wang Z, Wei LQ, Wu X, Xu XJ, Yan L, Yang J, Yang WQ, Yao NL, Zhang DL, Zhang JQ, Zhang MM, Zhang YL, Zhou CH, Yan CG, Zuo XN, Hallett M, Wu T, Zang YF. Small P values may not yield robust findings: an example using REST-meta-PD. Sci Bull (Beijing) 2021; 66:2148-2152. [PMID: 36654102 DOI: 10.1016/j.scib.2021.06.007] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Affiliation(s)
- Xi-Ze Jia
- Center for Cognition and Brain Disorders, the Affiliated Hospital, Hangzhou Normal University, Hangzhou 310015, China; Zhejiang Key Laboratory for Research in Assessment of Cognitive Impairments, Hangzhou 311121, China
| | - Na Zhao
- Center for Cognition and Brain Disorders, the Affiliated Hospital, Hangzhou Normal University, Hangzhou 310015, China; Zhejiang Key Laboratory for Research in Assessment of Cognitive Impairments, Hangzhou 311121, China
| | - Hao-Ming Dong
- National Basic Science Data Center, Beijing 100190, China; State Key Laboratory of Cognitive Neuroscience and Learning & McGovern Institute for Brain Research, Beijing Normal University, Beijing 100875, China
| | - Jia-Wei Sun
- School of Information and Electronics Technology, Jiamusi University, Jiamusi 154007, China
| | - Marek Barton
- Neuroscience Program, Central European Institute of Technology, CEITEC, Masaryk University, Brno 62500, Czech Republic
| | - Roxana Burciu
- Department of Applied Physiology and Kinesiology, University of Florida, Gainesville FL 32611, USA
| | - Nicolas Carrière
- Univ. Lille, Inserm, CHU Lille, U1172 - LilNCog - Lille Neuroscience & Cognition, Lille F-59000, France
| | - Antonio Cerasa
- The Institute for Biomedical Research and Innovation, National Research Council, Mangone CS 87050, Italy
| | - Bo-Yu Chen
- Department of Radiology, The First Affiliated Hospital of China Medical University, Shenyang 110001, China
| | - Jun Chen
- Department of Radiology, Guangdong Provincial Hospital of Chinese Medicine, Guangzhou 510120, China
| | - Stephen Coombes
- Department of Applied Physiology and Kinesiology, University of Florida, Gainesville FL 32611, USA
| | - Luc Defebvre
- Univ. Lille, Inserm, CHU Lille, U1172 - LilNCog - Lille Neuroscience & Cognition, Lille F-59000, France
| | - Christine Delmaire
- Univ. Lille, Inserm, CHU Lille, U1172 - LilNCog - Lille Neuroscience & Cognition, Lille F-59000, France
| | - Kathy Dujardin
- Univ. Lille, Inserm, CHU Lille, U1172 - LilNCog - Lille Neuroscience & Cognition, Lille F-59000, France
| | - Fabrizio Esposito
- Department of Medicine, Surgery and Dentistry, Scuola Medica Salernitana, University of Salerno, Fisciano, SA 132-84084, Italy
| | - Guo-Guang Fan
- Department of Radiology, The First Affiliated Hospital of China Medical University, Shenyang 110001, China
| | - Federica Di Nardo
- Department of Advanced Medical and Surgery Sciences, University of Campania "Luigi Vanvitelli", Caserta 81100, Italy
| | - Yi-Xuan Feng
- Eye Center of the 2nd Affiliated Hospital, Medical College of Zhejiang University, Hangzhou 310020, China; Zhejiang Provincial Key Lab of Ophthalmology, Hangzhou 310020, China
| | - Brett W Fling
- Department of Health and Exercise Science, Colorado State University, Fort Collins CO 80523, USA
| | - Saurabh Garg
- Department of Health and Exercise Science, Colorado State University, Fort Collins CO 80523, USA; Department of Medicine (Neurology) University of British Columbia, Vancouver BC V6T 1B7, Canada
| | - Moran Gilat
- Brain and Mind Center, The University of Sydney, Sydney NSW 2006, Australia
| | - Martin Gorges
- Department of Neurology, Ulm University, Ulm 89081, Germany
| | - Shu-Leong Ho
- Division of Neurology, Department of Medicine, Queen Mary Hospital, University of Hong Kong, Hong Kong 999077, China
| | - Fay B Horak
- Department of Neurology, School of Medicine, Oregon Health & Science University, Oregon 97239-3098, USA; VA Portland Health Care System, Portland OR 97239, USA
| | - Xiao Hu
- Department of Radiology, The Affiliated Brain Hospital with Nanjing Medical University, Nanjing 210029, China
| | - Xiao-Fei Hu
- Department of Radiology, Southwest Hospital, Third Military Medical University, Chongqing 400038, China
| | - Biao Huang
- Department of Radiology, Guangdong Academy of Medical Sciences, Guangzhou 510080, China
| | - Pei-Yu Huang
- Department of Radiology, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310009, China
| | - Ze-Juan Jia
- Graduate School of Hebei Medical University, Shijiazhuang 50017, China
| | - Christina Jones
- Pacific Parkinson's Research Centre, University of British Columbia, Vancouver BC V6E 2M6, Canada; Department of Medicine (Neurology) University of British Columbia, Vancouver BC V6T 1B7, Canada
| | - Jan Kassubek
- Department of Neurology, Ulm University, Ulm 89081, Germany
| | - Lenka Krajcovicova
- Neuroscience Program, Central European Institute of Technology, CEITEC, Masaryk University, Brno 62500, Czech Republic
| | - Ajay Kurani
- Department of Neurology, Northwestern University Feinberg School of Medicine, Chicago IL 60611, USA
| | - Jing Li
- Department of Neurology, Southwest Hospital, Third Military Medical University, Chongqing 400038, China
| | - Qing Li
- College of Information Science and Technology, Beijing Normal University, Beijing 100875, China
| | - Ai-Ping Liu
- Department of Electrical and Computer Engineering, University of British Columbia, Vancouver BC V6T 1Z4, Canada
| | - Bo Liu
- Department of Radiology, Guangdong Provincial Hospital of Chinese Medicine, Guangzhou 510120, China
| | - Hu Liu
- Department of Radiology, The First Affiliated Hospital of China Medical University, Shenyang 110001, China
| | - Wei-Guo Liu
- Department of Neurology, The Affiliated Brain Hospital With Nanjing Medical University, Nanjing 210029, China
| | - Renaud Lopes
- Univ. Lille, Inserm, CHU Lille, U1172 - LilNCog - Lille Neuroscience & Cognition, Lille F-59000, France
| | - Yu-Ting Lou
- Department of Paediatrics, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310009, China
| | - Wei Luo
- Department of Neurology, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310009, China
| | - Tara Madhyastha
- Department of Radiology, University of Washington, Seattle WA 98195-7117, USA
| | - Ni-Ni Mao
- College of Information Science and Technology, Beijing Normal University, Beijing 100875, China
| | - Grainne McAlonan
- South London and Maudsley NHS Foundation Trust, London BR3 3BX, UK; State Key Laboratory for Cognitive Sciences, The University of Hong Kong, Hong Kong 999077, China; Department of Forensic and Neurodevelopmental Science, Institute of Psychiatry, King's College London, London WC2R 2LS, UK
| | - Martin J McKeown
- Pacific Parkinson's Research Centre, University of British Columbia, Vancouver BC V6E 2M6, Canada; Department of Medicine (Neurology) University of British Columbia, Vancouver BC V6T 1B7, Canada
| | - Shirley Pang
- Division of Neurology, Department of Medicine, Queen Mary Hospital, University of Hong Kong, Hong Kong 999077, China
| | - Andrea Quattrone
- Institute of Neurology, University Magna Graecia of Catanzaro, Catanzaro CZ 88100, Italy
| | - Irena Rektorova
- Neuroscience Program, Central European Institute of Technology, CEITEC, Masaryk University, Brno 62500, Czech Republic
| | - Alessia Sarica
- Neuroscience Center, Department of Medical and Surgical Sciences, Magna Graecia University of Catanzaro, Catanzaro CZ 88100, Italy
| | - Hui-Fang Shang
- Department of Neurology, West China Hospital, Sichuan University, Chengdu 610065, China
| | - James M Shine
- Brain and Mind Center, The University of Sydney, Sydney NSW 2006, Australia
| | | | - Tomas Slavicek
- Neuroscience Program, Central European Institute of Technology, CEITEC, Masaryk University, Brno 62500, Czech Republic
| | - Xiao-Peng Song
- Department of Neurology, The Affiliated Brain Hospital With Nanjing Medical University, Nanjing 210029, China
| | - Gioacchino Tedeschi
- Department of Advanced Medical and Surgery Sciences, University of Campania "Luigi Vanvitelli", Caserta 81100, Italy
| | - Alessandro Tessitore
- Department of Advanced Medical and Surgery Sciences, University of Campania "Luigi Vanvitelli", Caserta 81100, Italy
| | - David Vaillancourt
- Department of Applied Physiology and Kinesiology, University of Florida, Gainesville FL 32611, USA
| | - Jian Wang
- Department of Radiology, Southwest Hospital, Third Military Medical University, Chongqing 400038, China
| | - Jue Wang
- School of Sports Medicine and Health, Chengdu Sport University, Chengdu 610041, China
| | - Z Jane Wang
- Department of Electrical and Computer Engineering, University of British Columbia, Vancouver BC V6T 1Z4, Canada
| | - Lu-Qing Wei
- Department of Neurology, The Affiliated Brain Hospital With Nanjing Medical University, Nanjing 210029, China
| | - Xia Wu
- College of Information Science and Technology, Beijing Normal University, Beijing 100875, China
| | - Xiao-Jun Xu
- Department of Radiology, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310009, China
| | - Lei Yan
- Department of Neurology, The Affiliated Brain Hospital With Nanjing Medical University, Nanjing 210029, China
| | - Jing Yang
- Department of Neurology, West China Hospital, Sichuan University, Chengdu 610065, China
| | - Wan-Qun Yang
- Department of Radiology, Guangdong Academy of Medical Sciences, Guangzhou 510080, China
| | - Nai-Lin Yao
- Department of Psychiatry, Queen Mary Hospital, The University of Hong Kong, Hong Kong 999077, China
| | - De-Long Zhang
- Department of Radiology, Guangdong Provincial Hospital of Chinese Medicine, Guangzhou 510120, China
| | - Jiu-Quan Zhang
- Department of Radiology, Southwest Hospital, Third Military Medical University, Chongqing 400038, China
| | - Min-Ming Zhang
- Department of Radiology, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310009, China
| | - Yan-Ling Zhang
- Department of Neurology, Southwest Hospital, Third Military Medical University, Chongqing 400038, China
| | - Cai-Hong Zhou
- Department of Radiology, Guangdong Academy of Medical Sciences, Guangzhou 510080, China
| | - Chao-Gan Yan
- National Basic Science Data Center, Beijing 100190, China
| | - Xi-Nian Zuo
- National Basic Science Data Center, Beijing 100190, China; State Key Laboratory of Cognitive Neuroscience and Learning & McGovern Institute for Brain Research, Beijing Normal University, Beijing 100875, China.
| | - Mark Hallett
- Human Motor Control Section, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda MD 20892, USA
| | - Tao Wu
- Department of Neurobiology, Neurology and Geriatrics, Xuanwu Hospital of Capital Medical University, Beijing Institute of Geriatrics, Beijing 100053, China; Clinical Center for Parkinson's Disease, Capital Medical University, Beijing 100069, China; Beijing Key Laboratory for Parkinson's Disease, Parkinson Disease Center of Beijing Institute for Brain Disorders, Beijing 100050, China; National Clinical Research Center for Geriatric Disorders, Beijing 100730, China
| | - Yu-Feng Zang
- Center for Cognition and Brain Disorders, the Affiliated Hospital, Hangzhou Normal University, Hangzhou 310015, China; Zhejiang Key Laboratory for Research in Assessment of Cognitive Impairments, Hangzhou 311121, China.
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12
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Hulzinga F, de Rond V, Vandendoorent B, Gilat M, Ginis P, D'Cruz N, Schlenstedt C, Nieuwboer A. Repeated Gait Perturbation Training in Parkinson's Disease and Healthy Older Adults: A Systematic Review and Meta-Analysis. Front Hum Neurosci 2021; 15:732648. [PMID: 34764860 PMCID: PMC8576267 DOI: 10.3389/fnhum.2021.732648] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2021] [Accepted: 09/27/2021] [Indexed: 11/13/2022] Open
Abstract
Background: Gait impairments are common in healthy older adults (HOA) and people with Parkinson's disease (PwPD), especially when adaptations to the environment are required. Traditional rehabilitation programs do not typically address these adaptive gait demands in contrast to repeated gait perturbation training (RGPT). RGPT is a novel reactive form of gait training with potential for both short and long-term consolidation in HOA and PwPD. The aim of this systematic review with meta-analysis is to determine whether RGPT is more effective than non-RGPT gait training in improving gait and balance in HOA and PwPD in the short and longer term. Methods: This review was conducted according to the PRISMA-guidelines and pre-registered in the PROSPERO database (CRD42020183273). Included studies tested the effects of any form of repeated perturbations during gait in HOA and PwPD on gait speed, step or stride length. Studies using balance scales or sway measures as outcomes were included in a secondary analysis. Effects of randomized controlled trials (RCT) on RGPT were pooled using a meta-analysis of final measures. Results: Of the 4421 studies, eight studies were deemed eligible for review, of which six could be included in the meta-analysis, totaling 209 participants (159 PwPD and 50 HOA). The studies were all of moderate quality. The meta-analysis revealed no significant effects of RGPT over non-RGPT training on gait performance (SMD = 0.16; 95% CI = -0.18, 0.49; Z = 0.92; P = 0.36). Yet, in some individual studies, favorable effects on gait speed, step length and stride length were observed immediately after the intervention as well as after a retention period. Gait variability and asymmetry, signifying more direct outcomes of gait adaptation, also indicated favorable RGPT effects in some individual studies. Conclusion: Despite some promising results, the pooled effects of RGPT on gait and balance were not significantly greater as compared to non-RGPT gait training in PwPD and HOA. However, these findings could have been driven by low statistical power. Therefore, the present review points to the imperative to conduct sufficiently powered RCT's to verify the true effects of RGPT on gait and balance in HOA and PwPD. Systematic Review Registration: https://www.crd.york.ac.uk/prospero/display_record.php? Identifier: CRD42020183273.
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Affiliation(s)
- Femke Hulzinga
- Neuromotor Rehabilitation Research Group, Department of Rehabilitation Sciences, KU Leuven, Leuven, Belgium
| | - Veerle de Rond
- Neuromotor Rehabilitation Research Group, Department of Rehabilitation Sciences, KU Leuven, Leuven, Belgium
| | - Britt Vandendoorent
- Neuromotor Rehabilitation Research Group, Department of Rehabilitation Sciences, KU Leuven, Leuven, Belgium
| | - Moran Gilat
- Neuromotor Rehabilitation Research Group, Department of Rehabilitation Sciences, KU Leuven, Leuven, Belgium
| | - Pieter Ginis
- Neuromotor Rehabilitation Research Group, Department of Rehabilitation Sciences, KU Leuven, Leuven, Belgium
| | - Nicholas D'Cruz
- Neuromotor Rehabilitation Research Group, Department of Rehabilitation Sciences, KU Leuven, Leuven, Belgium
| | - Christian Schlenstedt
- Department of Neurology, University Hospital Schleswig-Holstein, Christian-Albrechts-University Kiel, Kiel, Germany
- Institute of Interdisciplinary Exercise Science and Sports Medicine, Department Performance, Neuroscience, Therapy and Health, Medical School Hamburg, Hamburg, Germany
| | - Alice Nieuwboer
- Neuromotor Rehabilitation Research Group, Department of Rehabilitation Sciences, KU Leuven, Leuven, Belgium
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13
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Gilat M, Ginis P, Zoetewei D, De Vleeschhauwer J, Hulzinga F, D'Cruz N, Nieuwboer A. A systematic review on exercise and training-based interventions for freezing of gait in Parkinson's disease. NPJ Parkinsons Dis 2021; 7:81. [PMID: 34508083 PMCID: PMC8433229 DOI: 10.1038/s41531-021-00224-4] [Citation(s) in RCA: 39] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2021] [Accepted: 08/12/2021] [Indexed: 12/16/2022] Open
Abstract
Freezing of gait (FOG) in Parkinson's disease (PD) causes severe patient burden despite pharmacological management. Exercise and training are therefore advocated as important adjunct therapies. In this meta-analysis, we assess the existing evidence for such interventions to reduce FOG, and further examine which type of training helps the restoration of gait function in particular. The primary meta-analysis across 41 studies and 1838 patients revealed a favorable moderate effect size (ES = -0.37) of various training modalities for reducing subjective FOG-severity (p < 0.00001), though several interventions were not directly aimed at FOG and some included non-freezers. However, exercise and training also proved beneficial in a secondary analysis on freezers only (ES = -0.32, p = 0.007). We further revealed that dedicated training aimed at reducing FOG episodes (ES = -0.24) or ameliorating the underlying correlates of FOG (ES = -0.40) was moderately effective (p < 0.01), while generic exercises were not (ES = -0.14, p = 0.12). Relevantly, no retention effects were seen after cessation of training (ES = -0.08, p = 0.36). This review thereby supports the implementation of targeted training as a treatment for FOG with the need for long-term engagement.
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Affiliation(s)
- Moran Gilat
- KU Leuven, Department of Rehabilitation Sciences, Neurorehabilitation Research Group (eNRGy), Leuven, Belgium.
| | - Pieter Ginis
- KU Leuven, Department of Rehabilitation Sciences, Neurorehabilitation Research Group (eNRGy), Leuven, Belgium
| | - Demi Zoetewei
- KU Leuven, Department of Rehabilitation Sciences, Neurorehabilitation Research Group (eNRGy), Leuven, Belgium
| | - Joni De Vleeschhauwer
- KU Leuven, Department of Rehabilitation Sciences, Neurorehabilitation Research Group (eNRGy), Leuven, Belgium
| | - Femke Hulzinga
- KU Leuven, Department of Rehabilitation Sciences, Neurorehabilitation Research Group (eNRGy), Leuven, Belgium
| | - Nicholas D'Cruz
- KU Leuven, Department of Rehabilitation Sciences, Neurorehabilitation Research Group (eNRGy), Leuven, Belgium
| | - Alice Nieuwboer
- KU Leuven, Department of Rehabilitation Sciences, Neurorehabilitation Research Group (eNRGy), Leuven, Belgium
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14
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Cao Z, John AR, Chen HT, Martens KE, Georgiades M, Gilat M, Nguyen HT, Lewis SJG, Lin CT. Identification of EEG Dynamics During Freezing of Gait and Voluntary Stopping in Patients With Parkinson's Disease. IEEE Trans Neural Syst Rehabil Eng 2021; 29:1774-1783. [PMID: 34428144 DOI: 10.1109/tnsre.2021.3107106] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
Mobility is severely impacted in patients with Parkinson's disease (PD), who often experience involuntary stopping from the freezing of gait (FOG). Understanding the neurophysiological difference between "voluntary stopping" and "involuntary stopping" caused by FOG is vital for the detection of and potential intervention for FOG in the daily lives of patients. This study characterised the electroencephalographic (EEG) signature associated with FOG in contrast to voluntary stopping. The protocol consisted of a timed up-and-go (TUG) task and an additional TUG task with a voluntary stopping component, where participants reacted to verbal "stop" and "walk" instructions by voluntarily stopping or walking. Event-related spectral perturbation (ERSP) analysis was performed to study the dynamics of the EEG spectra induced by different walking phases, including normal walking, voluntary stopping and episodes of involuntary stopping (FOG), as well as the transition windows between normal walking and voluntary stopping or FOG. These results demonstrate for the first time that the EEG signal during the transition from walking to voluntary stopping is distinguishable from that during the transition to involuntary stopping caused by FOG. The EEG signature of voluntary stopping exhibits a significantly decreased power spectrum compared with that of FOG episodes, with distinctly different patterns in the delta and low-beta power in the central area. These findings suggest the possibility of a practical EEG-based tool that can accurately predict FOG episodes, excluding the potential confounding of voluntary stopping.
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Dijkstra BW, Gilat M, Cofré Lizama LE, Mancini M, Bergmans B, Verschueren SMP, Nieuwboer A. Impaired Weight-Shift Amplitude in People with Parkinson's Disease with Freezing of Gait. J Parkinsons Dis 2021; 11:1367-1380. [PMID: 33749618 DOI: 10.3233/jpd-202370] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND People with Parkinson's disease and freezing of gait (FOG; freezers) suffer from pronounced postural instability. However, the relationship between these phenomena remains unclear and has mostly been tested in paradigms requiring step generation. OBJECTIVE To determine if freezing-related dynamic balance deficits are present during a task without stepping and determine the influence of dopaminergic medication on dynamic balance control. METHODS Twenty-two freezers, 16 non-freezers, and 20 healthy age-matched controls performed mediolateral weight-shifts at increasing frequencies when following a visual target projected on a screen (MELBA task). The amplitude and phase shift differences between center of mass and target motion were measured. Balance scores (Mini-BESTest), 360° turning speed and the freezing ratio were also measured. Subjects with Parkinson's disease were tested ON and partial OFF (overnight withdrawal) dopaminergic medication. RESULTS Freezers had comparable turning speed and balance scores to non-freezers and took more levodopa. Freezers produced hypokinetic weight-shift amplitudes throughout the MELBA task compared to non-freezers (p = 0.002), which were already present at task onset (p < 0.001). Freezers also displayed an earlier weight-shift breakdown than controls when OFF-medication (p = 0.008). Medication improved mediolateral weight-shifting in freezers and non-freezers. Freezers decreased their freezing ratio in response to medication. CONCLUSION Hypokinetic weight-shifting proved a marked postural control deficit in freezers, while balance scores and turning speed were similar to non-freezers. Both weight-shift amplitudes and the freezing ratio were responsive to medication in freezers, suggesting axial motor vigor is levodopa-responsive. Future work needs to test whether weight-shifting and freezing severity can be further ameliorated through training.
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Affiliation(s)
- Bauke W Dijkstra
- Neuromotor Rehabilitation Research Group, Department of Rehabilitation Sciences, KU Leuven, Leuven, Belgium
| | - Moran Gilat
- Neuromotor Rehabilitation Research Group, Department of Rehabilitation Sciences, KU Leuven, Leuven, Belgium
| | - L Eduardo Cofré Lizama
- School of Allied Health, Human Services and Sports, La Trobe University, Victoria, Australia
| | - Martina Mancini
- Department of Neurology, Oregon Health & Science University, Portland, Oregon, USA
| | - Bruno Bergmans
- Department of Neurology, AZ Sint-Jan Brugge-Oostende AV, Bruges, Belgium.,Department of Neurology, Ghent University Hospital, Ghent, Belgium
| | - Sabine M P Verschueren
- Research Group for Musculoskeletal Rehabilitation, Department of Rehabilitation Sciences, KU Leuven, Leuven, Belgium
| | - Alice Nieuwboer
- Neuromotor Rehabilitation Research Group, Department of Rehabilitation Sciences, KU Leuven, Leuven, Belgium
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16
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Affiliation(s)
- Moran Gilat
- KU Leuven, Department of Rehabilitation Sciences, Neurorehabilitation Research Group (eNRGy), Leuven 3000, Belgium.
| | - Nicholas D'Cruz
- KU Leuven, Department of Rehabilitation Sciences, Neurorehabilitation Research Group (eNRGy), Leuven 3000, Belgium
| | - Pieter Ginis
- KU Leuven, Department of Rehabilitation Sciences, Neurorehabilitation Research Group (eNRGy), Leuven 3000, Belgium
| | - Wim Vandenberghe
- KU Leuven, Department of Neurosciences, Laboratory for Parkinson Research, Leuven, Belgium; University Hospitals Leuven, Department of Neurology, Leuven, Belgium
| | - Alice Nieuwboer
- KU Leuven, Department of Rehabilitation Sciences, Neurorehabilitation Research Group (eNRGy), Leuven 3000, Belgium
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17
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D'Cruz N, Vervoort G, Chalavi S, Dijkstra BW, Gilat M, Nieuwboer A. Thalamic morphology predicts the onset of freezing of gait in Parkinson's disease. NPJ Parkinsons Dis 2021; 7:20. [PMID: 33654103 PMCID: PMC7925565 DOI: 10.1038/s41531-021-00163-0] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2020] [Accepted: 01/14/2021] [Indexed: 11/08/2022] Open
Abstract
The onset of freezing of gait (FOG) in Parkinson's disease (PD) is a critical milestone, marked by a higher risk of falls and reduced quality of life. FOG is associated with alterations in subcortical neural circuits, yet no study has assessed whether subcortical morphology can predict the onset of clinical FOG. In this prospective multimodal neuroimaging cohort study, we performed vertex-based analysis of grey matter morphology in fifty-seven individuals with PD at study entry and two years later. We also explored the behavioral correlates and resting-state functional connectivity related to these local volume differences. At study entry, we found that freezers (N = 12) and persons who developed FOG during the course of the study (converters) (N = 9) showed local inflations in bilateral thalamus in contrast to persons who did not (non-converters) (N = 36). Longitudinally, converters (N = 7) also showed local inflation in the left thalamus, as compared to non-converters (N = 36). A model including sex, daily levodopa equivalent dose, and local thalamic inflation predicted conversion with good accuracy (AUC: 0.87, sensitivity: 88.9%, specificity: 77.8%). Exploratory analyses showed that local thalamic inflations were associated with larger medial thalamic sub-nuclei volumes and better cognitive performance. Resting-state analyses further revealed that converters had stronger thalamo-cortical coupling with limbic and cognitive regions pre-conversion, with a marked reduction in coupling over the two years. Finally, validation using the PPMI cohort suggested FOG-specific non-linear evolution of thalamic local volume. These findings provide markers of, and deeper insights into conversion to FOG, which may foster earlier intervention and better mobility for persons with PD.
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Affiliation(s)
- Nicholas D'Cruz
- KU Leuven, Department of Rehabilitation Sciences, Neurorehabilitation Research Group, B-3000, Leuven, Belgium.
| | - Griet Vervoort
- KU Leuven, Department of Rehabilitation Sciences, Neurorehabilitation Research Group, B-3000, Leuven, Belgium
| | - Sima Chalavi
- KU Leuven, Department of Movement Sciences, Movement Control & Neuroplasticity Research Group, B-3000, Leuven, Belgium
| | - Bauke W Dijkstra
- KU Leuven, Department of Rehabilitation Sciences, Neurorehabilitation Research Group, B-3000, Leuven, Belgium
| | - Moran Gilat
- KU Leuven, Department of Rehabilitation Sciences, Neurorehabilitation Research Group, B-3000, Leuven, Belgium
| | - Alice Nieuwboer
- KU Leuven, Department of Rehabilitation Sciences, Neurorehabilitation Research Group, B-3000, Leuven, Belgium
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18
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Nonnekes J, Gilat M, DʼCruz N, Dijkstra BW, Bloem BR, Nieuwboer A. Letter to the Editor on "A Randomized, Controlled Trial of Exercise for Parkinsonian Individuals With Freezing of Gait". Mov Disord 2021; 35:2122-2123. [PMID: 33463747 PMCID: PMC7756703 DOI: 10.1002/mds.28294] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2020] [Revised: 07/23/2020] [Accepted: 07/27/2020] [Indexed: 01/05/2023] Open
Affiliation(s)
- Jorik Nonnekes
- Radboud University Medical Centre; Donders Institute for Brain, Cognition and Behaviour, Department of Rehabilitation, Nijmegen, the Netherlands
| | - Moran Gilat
- Department of Rehabilitation Sciences, Neurorehabilitation Research Group (eNRGy), KU Leuven, Leuven, Belgium
| | - Nicholas DʼCruz
- Department of Rehabilitation Sciences, Neurorehabilitation Research Group (eNRGy), KU Leuven, Leuven, Belgium
| | - Bauke W Dijkstra
- Department of Rehabilitation Sciences, Neurorehabilitation Research Group (eNRGy), KU Leuven, Leuven, Belgium
| | - Bastiaan R Bloem
- Department of Neurology, Radboud University Medical Centre, Donders Institute for Brain, Cognition and Behaviour, Nijmegen, the Netherlands
| | - Alice Nieuwboer
- Department of Rehabilitation Sciences, Neurorehabilitation Research Group (eNRGy), KU Leuven, Leuven, Belgium
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19
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Abstract
Visually scoring freezing of gait (FOG) from video is increasingly recognized as the gold-standard for assessing FOG severity in Parkinson's disease. Surprisingly, no guidelines exist on how to visually score FOG. Here, I present a free template that can be implemented in open-source software to annotate FOG from video. I provide a user guide on how to implement the template and standardize the scoring of FOG and the percentage of time spent with FOG (% FOG). It is hoped that by disseminating this method investigators will be better able to employ % FOG as an outcome in their studies and therapeutic trials.
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Affiliation(s)
- Moran Gilat
- Research Group for Neurorehabilitation (eNRGy), Department of Rehabilitation Sciences, KU Leuven, Tervuursevest, Belgium
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20
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Dijkstra BW, Bekkers EMJ, Gilat M, de Rond V, Hardwick RM, Nieuwboer A. Functional neuroimaging of human postural control: A systematic review with meta-analysis. Neurosci Biobehav Rev 2020; 115:351-362. [PMID: 32407735 DOI: 10.1016/j.neubiorev.2020.04.028] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2019] [Revised: 04/07/2020] [Accepted: 04/23/2020] [Indexed: 02/03/2023]
Abstract
Postural instability is a strong risk factor for falls that becomes more prominent with aging. To facilitate treatment and prevention of falls in an aging society, a thorough understanding of the neural networks underlying postural control is warranted. Here, we present a systematic review of the functional neuroimaging literature of studies measuring posture-related neural activity in healthy subjects. Study methods were overall heterogeneous. Eleven out of the 14 studies relied on postural simulation in a supine position (e.g. motor imagery). The key nodes of human postural control involved the brainstem, cerebellum, basal ganglia, thalamus and several cortical regions. An activation likelihood estimation meta-analysis revealed that the anterior cerebellum was consistently activated across the wide range of postural tasks. The cerebellum is known to modulate the brainstem nuclei involved in the control of posture. Hence, this systematic review with meta-analysis provides insight into the neural correlates which underpin human postural control and which may serve as a reference for future neural network and region of interest analyses.
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Affiliation(s)
- Bauke W Dijkstra
- Neuromotor Rehabilitation Research Group, Department of Rehabilitation Sciences, KU Leuven, Tervuursevest 101, Bus 1501, 3001, Leuven, Belgium.
| | - Esther M J Bekkers
- Neuromotor Rehabilitation Research Group, Department of Rehabilitation Sciences, KU Leuven, Tervuursevest 101, Bus 1501, 3001, Leuven, Belgium.
| | - Moran Gilat
- Neuromotor Rehabilitation Research Group, Department of Rehabilitation Sciences, KU Leuven, Tervuursevest 101, Bus 1501, 3001, Leuven, Belgium.
| | - Veerle de Rond
- Neuromotor Rehabilitation Research Group, Department of Rehabilitation Sciences, KU Leuven, Tervuursevest 101, Bus 1501, 3001, Leuven, Belgium.
| | - Robert M Hardwick
- Movement Control and Neuroplasticity Research Group, Department of Movement Sciences, KU Leuven, Tervuursevest 101, Bus 1501, 3001, Leuven, Belgium; Institute of Neuroscience, Université Catholique De Louvain, Brussels, Belgium.
| | - Alice Nieuwboer
- Neuromotor Rehabilitation Research Group, Department of Rehabilitation Sciences, KU Leuven, Tervuursevest 101, Bus 1501, 3001, Leuven, Belgium.
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21
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Gilat M, Coeytaux Jackson A, Marshall NS, Hammond D, Mullins AE, Hall JM, Fang BAM, Yee BJ, Wong KKH, Grunstein RR, Lewis SJG. Melatonin for rapid eye movement sleep behavior disorder in Parkinson's disease: A randomised controlled trial. Mov Disord 2019; 35:344-349. [PMID: 31674060 PMCID: PMC7027846 DOI: 10.1002/mds.27886] [Citation(s) in RCA: 72] [Impact Index Per Article: 14.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2019] [Revised: 09/13/2019] [Accepted: 09/15/2019] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND Melatonin may reduce REM-sleep behavior disorder (RBD) symptoms in Parkinson's disease (PD), though robust clinical trials are lacking. OBJECTIVE To assess the efficacy of prolonged-release (PR) melatonin for RBD in PD. METHODS Randomized, double-blind, placebo-controlled, parallel-group trial with an 8-week intervention and 4-week observation pre- and postintervention (ACTRN12613000648729). Thirty PD patients with rapid eye movement sleep behavior disorder were randomized to 4 mg of prolonged-release melatonin (Circadin) or matched placebo, ingested orally once-daily before bedtime. Primary outcome was the aggregate of rapid eye movement sleep behavior disorder incidents averaged over weeks 5 to 8 of treatment captured by a weekly diary. Data were included in a mixed-model analysis of variance (n = 15 per group). RESULTS No differences between groups at the primary endpoint (3.4 events/week melatonin vs. 3.6 placebo; difference, 0.2; 95% confidence interval = -3.2 to 3.6; P = 0.92). Adverse events included mild headaches, fatigue, and morning sleepiness (n = 4 melatonin; n = 5 placebo). CONCLUSION Prolonged-release melatonin 4 mg did not reduce rapid eye movement sleep behavior disorder in PD. © 2019 The Authors. Movement Disorders published by Wiley Periodicals, Inc. on behalf of International Parkinson and Movement Disorder Society.
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Affiliation(s)
- Moran Gilat
- Woolcock Institute of Medical Research, The University of Sydney, Sydney, Australia.,ForeFront Parkinson's Disease Research Clinic, Brain and Mind Centre, The University of Sydney, Sydney, Australia.,Research Group for Neurorehabilitation (eNRGy), Department of Rehabilitation Sciences, KU Leuven, Leuven, Belgium
| | - Alessandra Coeytaux Jackson
- Woolcock Institute of Medical Research, The University of Sydney, Sydney, Australia.,Department of Neurology, University Hospitals of Geneva, Switzerland
| | - Nathaniel S Marshall
- Woolcock Institute of Medical Research, The University of Sydney, Sydney, Australia
| | - Deborah Hammond
- ForeFront Parkinson's Disease Research Clinic, Brain and Mind Centre, The University of Sydney, Sydney, Australia
| | - Anna E Mullins
- Woolcock Institute of Medical Research, The University of Sydney, Sydney, Australia
| | - Julie M Hall
- ForeFront Parkinson's Disease Research Clinic, Brain and Mind Centre, The University of Sydney, Sydney, Australia
| | - Bernard A M Fang
- Woolcock Institute of Medical Research, The University of Sydney, Sydney, Australia
| | - Brendon J Yee
- Woolcock Institute of Medical Research, The University of Sydney, Sydney, Australia.,Department of Respiratory and Sleep Medicine, Royal Prince Alfred Hospital, Sydney, Australia
| | - Keith K H Wong
- Woolcock Institute of Medical Research, The University of Sydney, Sydney, Australia.,Department of Respiratory and Sleep Medicine, Royal Prince Alfred Hospital, Sydney, Australia
| | - Ron R Grunstein
- Woolcock Institute of Medical Research, The University of Sydney, Sydney, Australia.,Department of Respiratory and Sleep Medicine, Royal Prince Alfred Hospital, Sydney, Australia
| | - Simon J G Lewis
- Woolcock Institute of Medical Research, The University of Sydney, Sydney, Australia.,ForeFront Parkinson's Disease Research Clinic, Brain and Mind Centre, The University of Sydney, Sydney, Australia
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22
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Georgiades MJ, Shine JM, Gilat M, McMaster J, Owler B, Mahant N, Lewis SJG. Hitting the brakes: pathological subthalamic nucleus activity in Parkinson’s disease gait freezing. Brain 2019; 142:3906-3916. [DOI: 10.1093/brain/awz325] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2019] [Accepted: 08/22/2019] [Indexed: 11/14/2022] Open
Abstract
The neurobiology of gait freezing in Parkinson’s disease is poorly understood and therapies are largely ineffective. Using a virtual reality task to elicit freezing intra-operatively during implantation of DBS electrodes, Georgiades et al. identify pathological subthalamic nucleus activity associated with freezing onset and discernible from that of volitional stopping.
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Affiliation(s)
- Matthew J Georgiades
- ForeFront Parkinson’s Disease Research Clinic, Brain and Mind Centre, University of Sydney, Australia
- Sydney Medical School, The University of Sydney, Australia
| | - James M Shine
- ForeFront Parkinson’s Disease Research Clinic, Brain and Mind Centre, University of Sydney, Australia
- Sydney Medical School, The University of Sydney, Australia
| | - Moran Gilat
- ForeFront Parkinson’s Disease Research Clinic, Brain and Mind Centre, University of Sydney, Australia
- Research Group for Neuromotor Rehabilitation, Department of Rehabilitation Sciences, KU Leuven, Belgium
| | | | - Brian Owler
- Westmead Private Hospital, Sydney, Australia
| | - Neil Mahant
- Sydney Medical School, The University of Sydney, Australia
- Westmead Private Hospital, Sydney, Australia
| | - Simon J G Lewis
- ForeFront Parkinson’s Disease Research Clinic, Brain and Mind Centre, University of Sydney, Australia
- Sydney Medical School, The University of Sydney, Australia
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23
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Ehgoetz Martens KA, Shine JM, Walton CC, Georgiades MJ, Gilat M, Hall JM, Muller AJ, Szeto JYY, Lewis SJG. Evidence for subtypes of freezing of gait in Parkinson's disease. Mov Disord 2019; 33:1174-1178. [PMID: 30153383 DOI: 10.1002/mds.27417] [Citation(s) in RCA: 57] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2017] [Revised: 03/20/2018] [Accepted: 03/23/2018] [Indexed: 11/11/2022] Open
Abstract
BACKGROUND The purpose of this study is to identify and characterize subtypes of freezing of gait by using a novel questionnaire designed to delineate freezing patterns based on self-reported and behavioral gait assessment. METHODS A total of 41 Parkinson's patients with freezing completed the Characterizing Freezing of Gait questionnaire that identifies situations that exacerbate freezing. This instrument underwent examination for construct validity and internal consistency, after which a data-driven clustering approach was employed to identify distinct patterns amongst individual responses. Behavioral freezing assessments in both dopaminergic states were compared across 3 identified subgroups. RESULTS This novel questionnaire demonstrated construct validity (severity scores correlated with percentage of time frozen; r = 0.54) and internal consistency (Cronbach's α = .937), and thus demonstrated promising utility for identifying patterns of freezing that are independently related to motor, anxiety, and attentional impairments. CONCLUSIONS Patients with freezing may be dissociable based on underlying neurobiological underpinnings that would have significant implications for targeting future treatments. © 2018 International Parkinson and Movement Disorder Society.
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Affiliation(s)
| | - James M Shine
- Forefront, Brain and Mind Centre, University of Sydney, New South Wales, Australia
| | - Courtney C Walton
- Forefront, Brain and Mind Centre, University of Sydney, New South Wales, Australia
| | - Matthew J Georgiades
- Forefront, Brain and Mind Centre, University of Sydney, New South Wales, Australia
| | - Moran Gilat
- Forefront, Brain and Mind Centre, University of Sydney, New South Wales, Australia
| | - Julie M Hall
- Forefront, Brain and Mind Centre, University of Sydney, New South Wales, Australia
| | - Alana J Muller
- Forefront, Brain and Mind Centre, University of Sydney, New South Wales, Australia
| | - Jennifer Y Y Szeto
- Forefront, Brain and Mind Centre, University of Sydney, New South Wales, Australia
| | - Simon J G Lewis
- Forefront, Brain and Mind Centre, University of Sydney, New South Wales, Australia
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24
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Ehgoetz Martens KA, Hall JM, Georgiades MJ, Gilat M, Walton CC, Matar E, Lewis SJG, Shine JM. The functional network signature of heterogeneity in freezing of gait. Brain 2019; 141:1145-1160. [PMID: 29444207 DOI: 10.1093/brain/awy019] [Citation(s) in RCA: 96] [Impact Index Per Article: 19.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2017] [Accepted: 12/12/2017] [Indexed: 11/12/2022] Open
Abstract
Freezing of gait is a complex, heterogeneous, and highly variable phenomenon whose pathophysiology and neural signature remains enigmatic. Evidence suggests that freezing is associated with impairments across cognitive, motor and affective domains; however, most research to date has focused on investigating one axis of freezing of gait in isolation. This has led to inconsistent findings and a range of different pathophysiological models of freezing of gait, due in large part to the tendency for studies to investigate freezing of gait as a homogeneous entity. To investigate the neural mechanisms of this heterogeneity, we used an established virtual reality paradigm to elicit freezing behaviour in 41 Parkinson's disease patients with freezing of gait and examined individual differences in the component processes (i.e. cognitive, motor and affective function) that underlie freezing of gait in conjunction with task-based functional MRI. First, we combined three unique components of the freezing phenotype: impaired set-shifting ability, step time variability, and self-reported anxiety and depression in a principal components analysis to estimate the severity of freezing behaviour with a multivariate approach. By combining these measures, we were then able to interrogate the pattern of task-based functional connectivity associated with freezing (compared to normal foot tapping) in a sub-cohort of 20 participants who experienced sufficient amounts of freezing during task functional MRI. Specifically, we used the first principal component from our behavioural analysis to classify patterns of functional connectivity into those that were associated with: (i) increased severity; (ii) increased compensation; or (iii) those that were independent of freezing severity. Coupling between the cognitive and limbic networks was associated with 'worse freezing severity', whereas anti-coupling between the putamen and the cognitive and limbic networks was related to 'increased compensation'. Additionally, anti-coupling between cognitive cortical regions and the caudate nucleus were 'independent of freezing severity' and thus may represent common neural underpinnings of freezing that are unaffected by heterogenous factors. Finally, we related these connectivity patterns to each of the individual components (cognitive, motor, affective) in turn, thus exposing latent heterogeneity in the freezing phenotype, while also identifying critical functional network signatures that may represent potential targets for novel therapeutic intervention. In conclusion, our findings provide confirmatory evidence for systems-level impairments in the pathophysiology of freezing of gait and further advance our understanding of the whole-brain deficits that mediate symptom expression in Parkinson's disease.
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Affiliation(s)
- Kaylena A Ehgoetz Martens
- Parkinson's Disease Research Clinic, Brain and Mind Centre, University of Sydney, Australia.,ForeFront, Brain and Mind Centre, University of Sydney, Australia
| | - Julie M Hall
- Parkinson's Disease Research Clinic, Brain and Mind Centre, University of Sydney, Australia.,ForeFront, Brain and Mind Centre, University of Sydney, Australia.,School of Social Sciences and Psychology, Western Sydney University, Australia
| | - Matthew J Georgiades
- Parkinson's Disease Research Clinic, Brain and Mind Centre, University of Sydney, Australia.,ForeFront, Brain and Mind Centre, University of Sydney, Australia
| | - Moran Gilat
- Parkinson's Disease Research Clinic, Brain and Mind Centre, University of Sydney, Australia.,ForeFront, Brain and Mind Centre, University of Sydney, Australia
| | - Courtney C Walton
- Parkinson's Disease Research Clinic, Brain and Mind Centre, University of Sydney, Australia.,ForeFront, Brain and Mind Centre, University of Sydney, Australia
| | - Elie Matar
- Parkinson's Disease Research Clinic, Brain and Mind Centre, University of Sydney, Australia.,ForeFront, Brain and Mind Centre, University of Sydney, Australia
| | - Simon J G Lewis
- Parkinson's Disease Research Clinic, Brain and Mind Centre, University of Sydney, Australia.,ForeFront, Brain and Mind Centre, University of Sydney, Australia
| | - James M Shine
- Parkinson's Disease Research Clinic, Brain and Mind Centre, University of Sydney, Australia.,ForeFront, Brain and Mind Centre, University of Sydney, Australia
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25
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Gilat M, Dijkstra BW, D'Cruz N, Nieuwboer A, Lewis SJG. Functional MRI to Study Gait Impairment in Parkinson's Disease: a Systematic Review and Exploratory ALE Meta-Analysis. Curr Neurol Neurosci Rep 2019; 19:49. [PMID: 31214901 DOI: 10.1007/s11910-019-0967-2] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
PURPOSE OF REVIEW Whilst gait impairment is a main cause for disability in Parkinson's disease (PD), its neural control remains poorly understood. We performed a systematic review and meta-analysis of neuroimaging studies of surrogate features of gait in PD. FINDINGS Assessing the results from PET or SPECT scans after a period of actual walking as well as fMRI during mental imagery or virtual reality (VR) gait paradigms, we found a varying pattern of gait-related brain activity. Overall, a decrease in activation of the SMA during gait was found in PD compared to elderly controls. In addition, the meta-analysis showed that the most consistent gait-related activation was situated in the cerebellar locomotor region (CLR) in PD. Despite methodological heterogeneity, the combined neuroimaging studies of gait provide new insights into its neural control in PD, suggesting that CLR activation likely serves a compensatory role in locomotion.
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Affiliation(s)
- Moran Gilat
- Department of Rehabilitation Sciences, KU Leuven, Tervuursevest 101, PO Box1501, Leuven, Belgium.
| | - Bauke W Dijkstra
- Department of Rehabilitation Sciences, KU Leuven, Tervuursevest 101, PO Box1501, Leuven, Belgium
| | - Nicholas D'Cruz
- Department of Rehabilitation Sciences, KU Leuven, Tervuursevest 101, PO Box1501, Leuven, Belgium
| | - Alice Nieuwboer
- Department of Rehabilitation Sciences, KU Leuven, Tervuursevest 101, PO Box1501, Leuven, Belgium
| | - Simon J G Lewis
- Brain and Mind Centre, University of Sydney, Sydney, Australia
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26
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Bell PT, Gilat M, Shine JM, McMahon KL, Lewis SJG, Copland DA. Neural correlates of emotional valence processing in Parkinson's disease: dysfunction in the subcortex. Brain Imaging Behav 2019; 13:189-199. [PMID: 28812218 DOI: 10.1007/s11682-017-9754-3] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
Parkinson's disease (PD) is frequently accompanied by cognitive and neuropsychiatric symptoms including impairments in affective processing. Despite this, mechanisms underlying vulnerability to deficits in affective processing remain unclear. In this study, we utilized functional Magnetic Resonance Imaging (fMRI) and an Affective Go-NoGo paradigm, to examine the neural correlates of emotional valence processing in PD. Results suggest that PD is associated with aberrant processing of emotional valence in subcortical limbic structures. Specifically, we found significant group-by-valence interactions in the ventral striatum and amygdala in response to words of differing emotional valence. Our findings contribute to a broader understanding of affective processing in PD and may provide insights into the mechanisms underlying vulnerability to mood disorders in PD.
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Affiliation(s)
- Peter T Bell
- Brain and Mind Centre, The University of Sydney, Sydney, NSW, Australia. .,University of Queensland Centre for Clinical Research, University of Queensland, Brisbane, QLD, Australia.
| | - Moran Gilat
- Brain and Mind Centre, The University of Sydney, Sydney, NSW, Australia
| | - James M Shine
- Brain and Mind Centre, The University of Sydney, Sydney, NSW, Australia
| | - Katie L McMahon
- Centre for Advanced Imaging, University of Queensland, Brisbane, QLD, Australia
| | - Simon J G Lewis
- Brain and Mind Centre, The University of Sydney, Sydney, NSW, Australia
| | - David A Copland
- University of Queensland Centre for Clinical Research, University of Queensland, Brisbane, QLD, Australia.,School of Health & Rehabilitation Sciences, University of Queensland, Brisbane, QLD, Australia
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27
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Nackaerts E, D'Cruz N, Dijkstra BW, Gilat M, Kramer T, Nieuwboer A. Towards understanding neural network signatures of motor skill learning in Parkinson's disease and healthy aging. Br J Radiol 2019; 92:20190071. [PMID: 30982328 DOI: 10.1259/bjr.20190071] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
In the past decade, neurorehabilitation has been shown to be an effective therapeutic supplement for patients with Parkinson's disease (PD). However, patients still experience severe problems with the consolidation of learned motor skills. Knowledge on the neural correlates underlying this process is thus essential to optimize rehabilitation for PD. This review investigates the existing studies on neural network connectivity changes in relation to motor learning in healthy aging and PD and critically evaluates the imaging methods used from a methodological point of view. The results indicate that despite neurodegeneration there is still potential to modify connectivity within and between motor and cognitive networks in response to motor training, although these alterations largely bypass the most affected regions in PD. However, so far training-related changes are inferred and possible relationships are not substantiated by brain-behavior correlations. Furthermore, the studies included suffer from many methodological drawbacks. This review also highlights the potential for using neural network measures as predictors for the response to rehabilitation, mainly based on work in young healthy adults. We speculate that future approaches, including graph theory and multimodal neuroimaging, may be more sensitive than brain activation patterns and model-based connectivity maps to capture the effects of motor learning. Overall, this review suggests that methodological developments in neuroimaging will eventually provide more detailed knowledge on how neural networks are modified by training, thereby paving the way for optimized neurorehabilitation for patients.
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Affiliation(s)
| | - Nicholas D'Cruz
- 1Department of Rehabilitation Sciences, KU Leuven, Leuven, Belgium
| | - Bauke W Dijkstra
- 1Department of Rehabilitation Sciences, KU Leuven, Leuven, Belgium
| | - Moran Gilat
- 1Department of Rehabilitation Sciences, KU Leuven, Leuven, Belgium
| | - Thomas Kramer
- 1Department of Rehabilitation Sciences, KU Leuven, Leuven, Belgium
| | - Alice Nieuwboer
- 1Department of Rehabilitation Sciences, KU Leuven, Leuven, Belgium
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28
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Matar E, Shine JM, Gilat M, Ehgoetz Martens KA, Ward PB, Frank MJ, Moustafa AA, Naismith SL, Lewis SJG. Identifying the neural correlates of doorway freezing in Parkinson's disease. Hum Brain Mapp 2019; 40:2055-2064. [PMID: 30637883 DOI: 10.1002/hbm.24506] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2018] [Revised: 12/10/2018] [Accepted: 12/18/2018] [Indexed: 11/10/2022] Open
Abstract
Freezing of gait (FOG) in Parkinson's disease (PD) is frequently triggered upon passing through narrow spaces such as doorways. However, despite being common the neural mechanisms underlying this phenomenon are poorly understood. In our study, 19 patients who routinely experience FOG performed a previously validated virtual reality (VR) gait paradigm where they used foot-pedals to navigate a series of doorways. Patients underwent testing randomised between both their "ON" and "OFF" medication states. Task performance in conjunction with blood oxygenation level dependent (BOLD) signal changes between "ON" and "OFF" states were compared within each patient. Specifically, as they passed through a doorway in the VR environment patients demonstrated significantly longer "footstep" latencies in the OFF state compared to the ON state. As seen clinically in FOG this locomotive delay was primarily triggered by narrow doorways rather than wide doorways. Functional magnetic resonance imaging revealed that footstep prolongation on passing through doorways was associated with selective hypoactivation in the presupplementary motor area (pSMA) bilaterally. Task-based functional connectivity analyses revealed that increased latency in response to doorways was inversely correlated with the degree of functional connectivity between the pSMA and the subthalamic nucleus (STN) across both hemispheres. Furthermore, increased frequency of prolonged footstep latency was associated with increased connectivity between the bilateral STN. These findings suggest that the effect of environmental cues on triggering FOG reflects a degree of impaired processing within the pSMA and disrupted signalling between the pSMA and STN, thus implicating the "hyperdirect" pathway in the generation of this phenomenon.
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Affiliation(s)
- Elie Matar
- Parkinson's Disease Research Clinic, Brain and Mind Centre, The University of Sydney, Camperdown, New South Wales, Australia.,Dementia and Movement Disorders Laboratory, Brain and Mind Centre, The University of Sydney, Sydney, New South Wales, Australia
| | - James M Shine
- Parkinson's Disease Research Clinic, Brain and Mind Centre, The University of Sydney, Camperdown, New South Wales, Australia
| | - Moran Gilat
- Parkinson's Disease Research Clinic, Brain and Mind Centre, The University of Sydney, Camperdown, New South Wales, Australia
| | - Kaylena A Ehgoetz Martens
- Parkinson's Disease Research Clinic, Brain and Mind Centre, The University of Sydney, Camperdown, New South Wales, Australia
| | - Philip B Ward
- Sydney & Schizophrenia Research Unit, South West Sydney Local Health District, School of Psychiatry, University of New South Wales, Sydney, New South Wales, Australia
| | - Michael J Frank
- Department of Cognitive, Linguistic and Psychological Sciences, Brown Institute for Brain Science, Brown University, Providence, Rhode Island
| | - Ahmed A Moustafa
- Parkinson's Disease Research Clinic, Brain and Mind Centre, The University of Sydney, Camperdown, New South Wales, Australia.,School of Social Sciences and Psychology, Marcs Institute for Brain and Behaviour, University of Western Sydney, Sydney, New South Wales, Australia
| | - Sharon L Naismith
- Parkinson's Disease Research Clinic, Brain and Mind Centre, The University of Sydney, Camperdown, New South Wales, Australia
| | - Simon J G Lewis
- Parkinson's Disease Research Clinic, Brain and Mind Centre, The University of Sydney, Camperdown, New South Wales, Australia
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29
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Gilat M. Towards closed-loop deep brain stimulation for freezing of gait in Parkinson's disease. Clin Neurophysiol 2018; 129:2448-2450. [PMID: 30195971 DOI: 10.1016/j.clinph.2018.08.012] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2018] [Accepted: 08/24/2018] [Indexed: 01/17/2023]
Affiliation(s)
- Moran Gilat
- Research Group for Neuromotor Rehabilitation, Department of Rehabilitation, KU Leuven, Leuven, Belgium.
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30
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Ardi Handojoseno AM, Gilat M, Ehgoetz Martens KA, Georgiades M, Naik GR, Tran Y, Lewis SJG, Nguyen HT. Detection of turning freeze in Parkinson's disease based on S-transform decomposition of EEG signals. Annu Int Conf IEEE Eng Med Biol Soc 2018; 2017:3044-3047. [PMID: 29060540 DOI: 10.1109/embc.2017.8037499] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Freezing of Gait (FOG) is a highly debilitating and poorly understood symptom of Parkinson's disease (PD), causing severe immobility and decreased quality of life. Turning Freezing (TF) is known as the most common sub-type of FOG, also causing the highest rate of falls in PD patients. During a TF, the feet of PD patients appear to become stuck whilst making a turn. This paper presents an electroencephalography (EEG) based classification method for detecting turning freezing episodes in six PD patients during Timed Up and Go Task experiments. Since EEG signals have a time-variant nature, time-frequency Stockwell Transform (S-Transform) techniques were used for feature extraction. The EEG sources were separated by means of independent component analysis using entropy bound minimization (ICA-EBM). The distinctive frequency-based features of selected independent components of EEG were extracted and classified using Bayesian Neural Networks. The classification demonstrated a high sensitivity of 84.2%, a specificity of 88.0% and an accuracy of 86.2% for detecting TF. These promising results pave the way for the development of a real-time device for detecting different sub-types of FOG during ambulation.
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Ly QT, Ardi Handojoseno AM, Gilat M, Chai R, Ehgoetz Martens KA, Georgiades M, Naik GR, Tran Y, Lewis SJG, Nguyen HT. Detection of gait initiation Failure in Parkinson's disease based on wavelet transform and Support Vector Machine. Annu Int Conf IEEE Eng Med Biol Soc 2018; 2017:3048-3051. [PMID: 29060541 DOI: 10.1109/embc.2017.8037500] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Gait initiation Failure (GIF) is the situation in which patients with Parkinson's disease (PD) feel as if their feet get "stuck" to the floor when initiating their first steps. GIF is a subtype of Freezing of Gait (FOG) and often leads to falls and related injuries. Understanding of neurobiological mechanisms underlying GIF has been limited by difficulties in eliciting and objectively characterizing such gait phenomena in the clinical setting. Studies investigating the effects of GIF on brain activity using EEG offer the potential to study such behavior. In this preliminary study, we present a novel methodology where wavelet transform was used for feature extraction and Support Vector Machine for classifying GIF events in five patients with PD and FOG. To deal with the large amount of EEG data, a Principal Component Analysis (PCA) was applied to reduce the data dimension from 15 EEG channels into 6 principal components (PCs), retaining 93% of the information. Independent Component Analysis using Entropy Bound Minimization (ICA-EBM) was applied to 6 PCs for source separation with the aim of improving detection ability of GIF events as compared to the normal initiation of gait (Good Starts). The results of this analysis demonstrated the correct identification of GIF episodes with an 83.1% sensitivity, 89.5% specificity and 86.3% accuracy. These results suggest that our proposed methodology is a promising non-invasive approach to improve GIF detection in PD and FOG.
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Matar E, Shine JM, Gilat M, Ehgoetz-Martens K, Ward PB, Frank MJ, Moustafa A, Naismith SL, Lewis SJG. 025 The neural correlates of doorway freezing in parkinson’s disease. J Neurol Neurosurg Psychiatry 2018. [DOI: 10.1136/jnnp-2018-anzan.24] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
IntroductionFreezing of gait (FOG) in Parkinson’s disease (PD) is a disabling symptom of advanced PD and is frequently triggered upon passing through narrow spaces such as doorways.1 Despite being common, the mechanisms underlying this phenomenon are poorly understood. We have previously shown that increased footstep latency in a virtual reality (VR) environment is a surrogate measure of FOG.2 In this study we aimed to model doorway freezing utilising the VR paradigm in conjunction with functional magnetic resonance imaging (fMRI) to determine the neural correlates of this phenomenon.MethodsIn our study, nineteen patients who routinely experience FOG performed a previously validated VR gait paradigm3 where they used foot-pedals to navigate a series of doorways. Patients underwent testing randomised between both their ‘ON’ and ‘OFF’ medication states. Task performance in conjunction with blood oxygenation level dependent signal changes were compared within each patient.ResultsWe were able to reproduce the finding that patients in the OFF state demonstrated significantly longer ‘footstep’ latencies as they passed through a doorway in the VR environment compared to the ON state. As seen clinically with FOG this locomotive delay was primarily triggered by narrow doorways rather than wide doorways. fMRI analysis revealed that doorway-provoked footstep delay was associated with selective hypoactivation in the pre-supplementary motor area (pSMA) bilaterally. Task-based functional connectivity analyses showed that this delay was inversely correlated with the degree of functional connectivity between the pSMA and the subthalamic nucleus (STN) across both hemispheres. Furthermore, increased frequency of prolonged footstep latency was associated with increased connectivity between the bilateral STN.ConclusionThese findings suggest that the effect of environmental cues on triggering FOG reflects a degree of impaired processing within the pSMA and disrupted signalling between the pSMA and STN, thus implicating the ‘hyperdirect’ pathway in the generation of this phenomenon.References. Giladi N, Treves TA, Simon ES, Shabtai H, Orlov Y, Kandinov B, Paleacu D, Korczyn AD. Freezing of gait in patients with advanced Parkinson’s disease. J Neural Transm (Vienna)2001;108:53–61.. Matar E, Shine JM, Naismith SL, Lewis SJ.Virtual realitywalking and dopamine: opening new doorways to understanding freezing of gait in Parkinson’s disease. J Neurol Sci 2014;344:182–5.. Shine JM, Matar E, Bolitho SJ, Dilda V, Morris TR, Naismith SL, Moore ST, Lewis SJ. Modelling freezing of gait in Parkinson’s disease with a virtual reality paradigm. Gait Posture2013;38:104–8.
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Walton CC, Mowszowski L, Gilat M, Hall JM, O'Callaghan C, Muller AJ, Georgiades M, Szeto JYY, Ehgoetz Martens KA, Shine JM, Naismith SL, Lewis SJG. Cognitive training for freezing of gait in Parkinson's disease: a randomized controlled trial. NPJ Parkinsons Dis 2018; 4:15. [PMID: 29796409 PMCID: PMC5959878 DOI: 10.1038/s41531-018-0052-6] [Citation(s) in RCA: 53] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/17/2018] [Revised: 04/11/2018] [Accepted: 04/17/2018] [Indexed: 01/01/2023]
Abstract
The pathophysiological mechanism of freezing of gait (FoG) has been linked to executive dysfunction. Cognitive training (CT) is a non-pharmacological intervention which has been shown to improve executive functioning in Parkinson’s disease (PD). This study aimed to explore whether targeted CT can reduce the severity of FoG in PD. Patients with PD who self-reported FoG and were free from dementia were randomly allocated to receive either a CT intervention or an active control. Both groups were clinician-facilitated and conducted twice-weekly for seven weeks. The primary outcome was percentage of time spent frozen during a Timed Up and Go task, assessed both on and off dopaminergic medications. Secondary outcomes included multiple neuropsychological and psychosocial measures. A full analysis was first conducted on all participants randomized, followed by a sample of interest including only those who had objective FoG at baseline, and completed the intervention. Sixty-five patients were randomized into the study. The sample of interest included 20 in the CT group and 18 in the active control group. The primary outcome of percentage time spent frozen during a gait task was significantly improved in the CT group compared to active controls in the on-state. There were no differences in the off-state. Patients who received CT also demonstrated improved processing speed and reduced daytime sleepiness compared to those in the active control. The findings suggest that CT can reduce the severity of FoG in the on-state, however replication in a larger sample is required. Cognitive training can reduce the severity of gait freezing in Parkinson’s disease (PD) patients on dopaminergic medication. The inability to move forwards despite the intention to walk is one of the most debilitating symptoms in patients with PD and has been linked to cognitive dysfunction. Simon Lewis at the University of Sydney, Australia, and colleagues examined the effects of cognitive training in patients with self-reported freezing of gait and without dementia. Patients receiving cognitive therapy twice a week for seven weeks showed a significant reduction in gait freezing compared to the control group. Interestingly, the effect was observed when patients had maximum benefit from their PD medication (on-state) but not in the off-state. Cognitive training also improved patients’ processing speed and reduced their daytime sleepiness highlighting the usefulness of non-pharmacological interventions in the treatment of PD.
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Affiliation(s)
- Courtney C Walton
- 1Parkinson's Disease Research Clinic, Brain and Mind Centre, University of Sydney, Camperdown, NSW Australia
| | - Loren Mowszowski
- 1Parkinson's Disease Research Clinic, Brain and Mind Centre, University of Sydney, Camperdown, NSW Australia.,2Healthy Brain Ageing Program, Brain and Mind Centre & Charles Perkins Centre, University of Sydney, Sydney, NSW Australia
| | - Moran Gilat
- 1Parkinson's Disease Research Clinic, Brain and Mind Centre, University of Sydney, Camperdown, NSW Australia
| | - Julie M Hall
- 1Parkinson's Disease Research Clinic, Brain and Mind Centre, University of Sydney, Camperdown, NSW Australia.,3School of Social Sciences and Psychology, Western Sydney University, Sydney, NSW Australia
| | - Claire O'Callaghan
- 1Parkinson's Disease Research Clinic, Brain and Mind Centre, University of Sydney, Camperdown, NSW Australia.,4Department of Psychiatry and Behavioural and Clinical Neuroscience Institute, University of Cambridge, Cambridge, UK
| | - Alana J Muller
- 1Parkinson's Disease Research Clinic, Brain and Mind Centre, University of Sydney, Camperdown, NSW Australia
| | - Matthew Georgiades
- 1Parkinson's Disease Research Clinic, Brain and Mind Centre, University of Sydney, Camperdown, NSW Australia
| | - Jennifer Y Y Szeto
- 1Parkinson's Disease Research Clinic, Brain and Mind Centre, University of Sydney, Camperdown, NSW Australia
| | - Kaylena A Ehgoetz Martens
- 1Parkinson's Disease Research Clinic, Brain and Mind Centre, University of Sydney, Camperdown, NSW Australia
| | - James M Shine
- 1Parkinson's Disease Research Clinic, Brain and Mind Centre, University of Sydney, Camperdown, NSW Australia.,5School of Psychology, Stanford University, Palo Alto, CA USA
| | - Sharon L Naismith
- 1Parkinson's Disease Research Clinic, Brain and Mind Centre, University of Sydney, Camperdown, NSW Australia.,2Healthy Brain Ageing Program, Brain and Mind Centre & Charles Perkins Centre, University of Sydney, Sydney, NSW Australia
| | - Simon J G Lewis
- 1Parkinson's Disease Research Clinic, Brain and Mind Centre, University of Sydney, Camperdown, NSW Australia
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Hall JM, Shine JM, Ehgoetz Martens KA, Gilat M, Broadhouse KM, Szeto JYY, Walton CC, Moustafa AA, Lewis SJG. Alterations in white matter network topology contribute to freezing of gait in Parkinson's disease. J Neurol 2018; 265:1353-1364. [PMID: 29616302 DOI: 10.1007/s00415-018-8846-3] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2018] [Revised: 03/16/2018] [Accepted: 03/21/2018] [Indexed: 12/31/2022]
Abstract
Freezing of gait (FOG) is a common symptom in advanced Parkinson's disease (PD). Despite current advances, the neural mechanisms underpinning this disturbance remain poorly understood. To this end, we investigated the structural organisation of the white matter connectome in PD freezers and PD non-freezers. We hypothesized that freezers would show an altered network architecture, which could hinder the effective information processing that characterizes the disorder. Twenty-six freezers and twenty-four well-matched non-freezers were included in this study. Using diffusion tensor imaging, we investigated the modularity and integration of the regional connectome by calculating the module degree z score and the participation coefficient, respectively. Compared to non-freezers, freezers demonstrated lower participation coefficients in the right caudate, thalamus, and hippocampus, as well as within superior frontal and parietal cortical regions. Importantly, several of these nodes were found within the brain's 'rich club'. Furthermore, group differences in module degree z scores within cortical frontal and sensory processing areas were found. Together, our results suggest that changes in the structural network topology contribute to the manifestation of FOG in PD, specifically due to a lack of structural integration between key information processing hubs of the brain.
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Affiliation(s)
- Julie M Hall
- School of Social Sciences and Psychology, Western Sydney University, Milperra, NSW, 2214, Australia
- Brain and Mind Centre, University of Sydney, 100 Mallett Street, Camperdown, NSW, 2050, Australia
| | - James M Shine
- Brain and Mind Centre, University of Sydney, 100 Mallett Street, Camperdown, NSW, 2050, Australia
| | | | - Moran Gilat
- Brain and Mind Centre, University of Sydney, 100 Mallett Street, Camperdown, NSW, 2050, Australia
| | - Kathryn M Broadhouse
- Brain and Mind Centre, University of Sydney, 100 Mallett Street, Camperdown, NSW, 2050, Australia
| | - Jennifer Y Y Szeto
- Brain and Mind Centre, University of Sydney, 100 Mallett Street, Camperdown, NSW, 2050, Australia
| | - Courtney C Walton
- Brain and Mind Centre, University of Sydney, 100 Mallett Street, Camperdown, NSW, 2050, Australia
| | - Ahmed A Moustafa
- School of Social Sciences and Psychology, Western Sydney University, Milperra, NSW, 2214, Australia
- MARCS Institute, Western Sydney University, Milperra, NSW, 2214, Australia
| | - Simon J G Lewis
- Brain and Mind Centre, University of Sydney, 100 Mallett Street, Camperdown, NSW, 2050, Australia.
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Gilat M, Ehgoetz Martens KA, Miranda-Domínguez O, Arpan I, Shine JM, Mancini M, Fair DA, Lewis SJG, Horak FB. Dysfunctional Limbic Circuitry Underlying Freezing of Gait in Parkinson's Disease. Neuroscience 2018; 374:119-132. [PMID: 29408498 DOI: 10.1016/j.neuroscience.2018.01.044] [Citation(s) in RCA: 82] [Impact Index Per Article: 13.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2017] [Revised: 01/18/2018] [Accepted: 01/20/2018] [Indexed: 11/18/2022]
Abstract
Freezing of gait (FOG) is a poorly understood symptom affecting many patients with Parkinson's disease (PD). Despite growing evidence of a behavioral link between anxiety, attention and FOG in PD, no research to date has investigated the neural mechanisms that might explain this relationship. The present study therefore examined resting-state MRI functional connectivity between the amygdala, striatum and frontoparietal attentional control network in PD patients with (freezers: n = 19) and without FOG (non-freezers: n = 21) in the dopaminergic 'off' state. Functional connectivity was subsequently correlated with an objective measure of FOG severity and a subjective scale of affective disorder within each group. Connectivity between the right amygdala and right putamen was significantly increased in freezers compared to non-freezers (p < 0.01). Furthermore, freezers showed increased anti-coupling between the frontoparietal network and left amygdala (p = 0.011), but reduced anti-coupling between this network and the right putamen (p = 0.027) as compared to non-freezers. Key functional connections between the amygdala, putamen and frontoparietal network were significantly associated with FOG severity and a fear of falling. This study provides the first evidence that dysfunctional fronto-striato-limbic processes may underpin the link between anxiety and FOG in PD. It is proposed that freezers have heightened striato-limbic load and reduced top-down attentional control at rest, which when further challenged by the parallel processing demands of walking may precipitate FOG.
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Affiliation(s)
- Moran Gilat
- Parkinson's Disease Research Clinic, Brain and Mind Centre, The University of Sydney, Sydney, NSW, Australia.
| | - Kaylena A Ehgoetz Martens
- Parkinson's Disease Research Clinic, Brain and Mind Centre, The University of Sydney, Sydney, NSW, Australia
| | - Oscar Miranda-Domínguez
- Department of Behavioral Neuroscience, Oregon Health & Science University, Portland, OR, USA
| | - Ishu Arpan
- Department of Neurology, Oregon Health & Science University, Portland, OR, USA
| | - James M Shine
- Parkinson's Disease Research Clinic, Brain and Mind Centre, The University of Sydney, Sydney, NSW, Australia
| | - Martina Mancini
- Department of Neurology, Oregon Health & Science University, Portland, OR, USA
| | - Damien A Fair
- Department of Behavioral Neuroscience, Oregon Health & Science University, Portland, OR, USA; Department of Psychiatry, Oregon Health & Science University, Portland, OR, USA; Advanced Imaging Research Center, Oregon Health & Science University, Portland, OR, USA
| | - Simon J G Lewis
- Parkinson's Disease Research Clinic, Brain and Mind Centre, The University of Sydney, Sydney, NSW, Australia
| | - Fay B Horak
- Department of Neurology, Oregon Health & Science University, Portland, OR, USA; Department of Biomedical Engineering, Oregon Health & Science University, Portland, OR, USA; Medical Veterans Affairs Portland Health Care System (VAPORHCS), Portland, OR, USA
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Handojoseno AMA, Naik GR, Gilat M, Shine JM, Nguyen TN, Ly QT, Lewis SJG, Nguyen HT. Prediction of Freezing of Gait in Patients with Parkinson's Disease Using EEG Signals. Stud Health Technol Inform 2018; 246:124-131. [PMID: 29507265] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Freezing of gait (FOG) is an episodic gait disturbance affecting initiation and continuation of locomotion in many Parkinson's disease (PD) patients, causing falls and a poor quality of life. FOG can be experienced on turning and start hesitation, passing through doorways or crowded areas dual tasking, and in stressful situations. Electroencephalography (EEG) offers an innovative technique that may be able to effectively foresee an impending FOG. From data of 16 PD patients, using directed transfer function (DTF) and independent component analysis (ICA) as data pre-processing, and an optimal Bayesian neural network as a predictor of a transition of 5 seconds before the impending FOG occurs in 11 in-group PD patients, we achieved sensitivity and specificity of 85.86% and 80.25% respectively in the test set (5 out-group PD patients). This study therefore contributes to the development of a non-invasive device to prevent freezing of gait in PD.
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Affiliation(s)
- A M Ardi Handojoseno
- Faculty of Science and Engineering, Santana Dharma University, Paingan, Sleman, Yogyakarta, Indonesia
| | - Ganesh R Naik
- Faculty of Engineering and Information Technology, University of Technology Sydney, New South Wales, Australia
| | - Moran Gilat
- Parkinson's Disease Research Clinic, Brain and Mind Centre, University of Sydney, New South Wales, Australia
| | - James M Shine
- Parkinson's Disease Research Clinic, Brain and Mind Centre, University of Sydney, New South Wales, Australia
| | - Tuan N Nguyen
- Faculty of Engineering and Information Technology, University of Technology Sydney, New South Wales, Australia
| | - Quynh T Ly
- Faculty of Engineering and Information Technology, University of Technology Sydney, New South Wales, Australia
| | - Simon J G Lewis
- Parkinson's Disease Research Clinic, Brain and Mind Centre, University of Sydney, New South Wales, Australia
| | - Hung T Nguyen
- Faculty of Engineering and Information Technology, University of Technology Sydney, New South Wales, Australia
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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Ardi Handojoseno AM, Gilat M, Tran Y, Lewis SJG, Nguyen HT. Detection of gait initiation failure in Parkinson's disease patients using EEG signals. Annu Int Conf IEEE Eng Med Biol Soc 2017; 2016:1599-1602. [PMID: 28268634 DOI: 10.1109/embc.2016.7591018] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Gait Initiation Failure (GIF) is one of the most disabling gait disturbances seen in advanced Parkinson's disease (PD). Gait Initiation is a complex motor task that requires motor and cognitive processing to enable the correct selection, timing and scaling of movement. Failure to initiate the first step often precipitates falls and leads to significant morbidity. However, the brain mechanisms underlying GIF remain unknown. This study utilized an ambulatory electroencephalography (EEG) technique to investigate the brain dynamic changes underlying GIF and aims to detect the occurrence of GIF in four PD patients. We sought to determine whether episodes of GIF might be associated with a characteristic brain signal that could be detected by surface EEG. This preliminary investigation analyzed the EEG signals through power spectra density (PSD) and centroid frequency (CF) to show that the GIF episodes were associated with significant increases in the high beta band (21-38Hz) across the central, frontal, occipital and parietal EEG sites. By implementing PSD and CF as input features with two-layer Back Propagation neural networks as a classifier, the proposed system was able to detect GIF events with a classification performance of 84.27% sensitivity and 84.80% accuracy. This is the first study to show cortical dynamic changes associated with GIF in Parkinson's disease, providing valuable information to enhance the performance of future GIF detection that could be translated into clinical practice.
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Ly QT, Ardi Handojoseno AM, Gilat M, Nguyen N, Tran Y, Lewis SJG, Nguyen HT. Identifying montages that best detect the electroencephalogram power spectrum alteration during freezing of gait in Parkinson's disease patients. Annu Int Conf IEEE Eng Med Biol Soc 2017; 2016:6094-6097. [PMID: 28269643 DOI: 10.1109/embc.2016.7592119] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Our research team has previously used four Electroencephalography (EEG) leads to successfully detect and predict Freezing of Gait (FOG) in Parkinson's disease (PD). However, it remained to be determined whether these four sensor locations that were arbitrarily chosen based on their role in motor control are indeed the most optimal for FOG detection. The aim of this study was therefore to determine the most optimal location and combination of sensors to detect FOG amongst a 32-channel EEG montage using our EEG classification system. EEG measures, including power spectral density, centroid frequency and power spectral entropy, were extracted from 7 patients with PD and FOG during a series of Timed up and Go tasks. By applying a feed-forward neural networks to classify EEG data, the obtained results showed that even a small number of electrodes suffice to construct a FOG detector with expected performance, which is comparable to the use of a full 32 channels montage. This finding therefore progresses the realization of a FOG detection system that can be effectively implemented on a daily basis for FOG prevention, improving the quality of life for many patients with PD.
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Affiliation(s)
- Peter T Bell
- University of Queensland Centre for Clinical Research, QLD, Australia
| | - Moran Gilat
- Brain and Mind Centre, The University of Sydney, NSW, Australia
| | - James M Shine
- Brain and Mind Centre, The University of Sydney, NSW, Australia
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Gilat M, Bell PT, Ehgoetz Martens KA, Georgiades MJ, Hall JM, Walton CC, Lewis SJG, Shine JM. Dopamine depletion impairs gait automaticity by altering cortico-striatal and cerebellar processing in Parkinson's disease. Neuroimage 2017; 152:207-220. [PMID: 28263926 DOI: 10.1016/j.neuroimage.2017.02.073] [Citation(s) in RCA: 70] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2016] [Revised: 02/22/2017] [Accepted: 02/24/2017] [Indexed: 12/11/2022] Open
Abstract
Impairments in motor automaticity cause patients with Parkinson's disease to rely on attentional resources during gait, resulting in greater motor variability and a higher risk of falls. Although dopaminergic circuitry is known to play an important role in motor automaticity, little evidence exists on the neural mechanisms underlying the breakdown of locomotor automaticity in Parkinson's disease. This impedes clinical management and is in great part due to mobility restrictions that accompany the neuroimaging of gait. This study therefore utilized a virtual reality gait paradigm in conjunction with functional MRI to investigate the role of dopaminergic medication on lower limb motor automaticity in 23 patients with Parkinson's disease that were measured both on and off dopaminergic medication. Participants either operated foot pedals to navigate a corridor ('walk' condition) or watched the screen while a researcher operated the paradigm from outside the scanner ('watch' condition), a setting that controlled for the non-motor aspects of the task. Step time variability during walk was used as a surrogate measure for motor automaticity (where higher variability equates to reduced automaticity), and patients demonstrated a predicted increase in step time variability during the dopaminergic "off" state. During the "off" state, subjects showed an increased blood oxygen level-dependent response in the bilateral orbitofrontal cortices (walk>watch). To estimate step time variability, a parametric modulator was designed that allowed for the examination of brain regions associated with periods of decreased automaticity. This analysis showed that patients on dopaminergic medication recruited the cerebellum during periods of increasing variability, whereas patients off medication instead relied upon cortical regions implicated in cognitive control. Finally, a task-based functional connectivity analysis was conducted to examine the manner in which dopamine modulates large-scale network interactions during gait. A main effect of medication was found for functional connectivity within an attentional motor network and a significant condition by medication interaction for functional connectivity was found within the striatum. Furthermore, functional connectivity within the striatum correlated strongly with increasing step time variability during walk in the off state (r=0.616, p=0.002), but not in the on state (r=-0.233, p=0.284). Post-hoc analyses revealed that functional connectivity in the dopamine depleted state within an orbitofrontal-striatal limbic circuit was correlated with worse step time variability (r=0.653, p<0.001). Overall, this study demonstrates that dopamine ameliorates gait automaticity in Parkinson's disease by altering striatal, limbic and cerebellar processing, thereby informing future therapeutic avenues for gait and falls prevention.
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Affiliation(s)
- Moran Gilat
- Parkinson's Disease Research Clinic, Brain and Mind Centre, The University of Sydney, Sydney, NSW, Australia.
| | - Peter T Bell
- University of Queensland Centre for Clinical Research, University of Queensland, Brisbane, QLD, Australia
| | - Kaylena A Ehgoetz Martens
- Parkinson's Disease Research Clinic, Brain and Mind Centre, The University of Sydney, Sydney, NSW, Australia
| | - Matthew J Georgiades
- Parkinson's Disease Research Clinic, Brain and Mind Centre, The University of Sydney, Sydney, NSW, Australia
| | - Julie M Hall
- Parkinson's Disease Research Clinic, Brain and Mind Centre, The University of Sydney, Sydney, NSW, Australia
| | - Courtney C Walton
- Parkinson's Disease Research Clinic, Brain and Mind Centre, The University of Sydney, Sydney, NSW, Australia
| | - Simon J G Lewis
- Parkinson's Disease Research Clinic, Brain and Mind Centre, The University of Sydney, Sydney, NSW, Australia
| | - James M Shine
- Department of Psychology, Stanford University, Stanford, CA, United States of America; Neuroscience Research Australia, Neuroscience Research Australia, University of New South Wales, Sydney, NSW, Australia
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Muralidharan V, Balasubramani PP, Chakravarthy VS, Gilat M, Lewis SJG, Moustafa AA. A Neurocomputational Model of the Effect of Cognitive Load on Freezing of Gait in Parkinson's Disease. Front Hum Neurosci 2017; 10:649. [PMID: 28119584 PMCID: PMC5220109 DOI: 10.3389/fnhum.2016.00649] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2016] [Accepted: 12/08/2016] [Indexed: 01/05/2023] Open
Abstract
Experimental data show that perceptual cues can either exacerbate or ameliorate freezing of gait (FOG) in Parkinson's Disease (PD). For example, simple visual stimuli like stripes on the floor can alleviate freezing whereas complex stimuli like narrow doorways can trigger it. We present a computational model of the cognitive and motor cortico-basal ganglia loops that explains the effects of sensory and cognitive processes on FOG. The model simulates strong causative factors of FOG including decision conflict (a disagreement of various sensory stimuli in their association with a response) and cognitive load (complexity of coupling a stimulus with downstream mechanisms that control gait execution). Specifically, the model simulates gait of PD patients (freezers and non-freezers) as they navigate a series of doorways while simultaneously responding to several Stroop word cues in a virtual reality setup. The model is based on an actor-critic architecture of Reinforcement Learning involving Utility-based decision making, where Utility is a weighted sum of Value and Risk functions. The model accounts for the following experimental data: (a) the increased foot-step latency seen in relation to high conflict cues, (b) the high number of motor arrests seen in PD freezers when faced with a complex cue compared to the simple cue, and (c) the effect of dopamine medication on these motor arrests. The freezing behavior arises as a result of addition of task parameters (doorways and cues) and not due to inherent differences in the subject group. The model predicts a differential role of risk sensitivity in PD freezers and non-freezers in the cognitive and motor loops. Additionally this first-of-its-kind model provides a plausible framework for understanding the influence of cognition on automatic motor actions in controls and Parkinson's Disease.
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Affiliation(s)
| | | | | | - Moran Gilat
- Parkinson's Disease Research Clinic, Brain and Mind Research Institute, University of Sydney Sydney, NSW, Australia
| | - Simon J G Lewis
- Parkinson's Disease Research Clinic, Brain and Mind Research Institute, University of Sydney Sydney, NSW, Australia
| | - Ahmed A Moustafa
- MARCS Institute for Brain and Behaviour and School of Social Sciences and Psychology, Western Sydney University Sydney, NSW, Australia
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Georgiades MJ, Gilat M, Ehgoetz Martens KA, Walton CC, Bissett PG, Shine JM, Lewis SJ. Investigating motor initiation and inhibition deficits in patients with Parkinson’s disease and freezing of gait using a virtual reality paradigm. Neuroscience 2016; 337:153-162. [DOI: 10.1016/j.neuroscience.2016.09.019] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2016] [Revised: 09/05/2016] [Accepted: 09/11/2016] [Indexed: 10/21/2022]
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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. J Parkinsons Dis 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] [What about the content of this article? (0)] [Affiliation(s)] [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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Handojoseno AMA, Gilat M, Ly QT, Chamtie H, Shine JM, Nguyen TN, Tran Y, Lewis SJG, Nguyen HT. An EEG study of turning freeze in Parkinson's disease patients: The alteration of brain dynamic on the motor and visual cortex. Annu Int Conf IEEE Eng Med Biol Soc 2016; 2015:6618-21. [PMID: 26737810 DOI: 10.1109/embc.2015.7319910] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Freezing of gait is a very debilitating symptom affecting many patients with Parkinson's disease, leading to a reduced mobility and increased risk for falls. Turning is known to be the most provocative trigger for freezing of gait. However, the underlying brain dynamic changes associated with a turning freeze remain unknown. This study therefore used ambulatory EEG to investigate the brain dynamic changes associated with freezing of gait during turning. In addition, this study aimed to determine the most suitable EEG sensor location to detect freezing of gait during turning using our classification system. Data from four Parkinson's disease patients with freezing of gait was analysed using power spectral density and brain effective connectivity, comparing periods of successful turning with freezing of gait during turning. Results showed that freezing of gait during turning is associated with significant alterations in the high beta and theta power spectral densities across the occipital and parietal areas. Furthermore, brain effective connectivity showed that freezing during turning was associated with increased connectivity towards the visual area, which also had the highest accuracy to detect freezing episodes in the O1 regions by using power spectral density in our classification analyses. This is the first study to show cortical dynamic changes associated with freezing of gait during turning, providing valuable information to enhance the performance of future freezing of gait detection systems.
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Szeto JY, Mowszowski L, Gilat M, Walton CC, Naismith SL, Lewis SJ. Mild Cognitive Impairment in Parkinson’s Disease: Impact on Caregiver Outcomes. JPD 2016; 6:589-96. [DOI: 10.3233/jpd-160823] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Jennifer Y.Y. Szeto
- Parkinson’s Disease Research Clinic, Brain and Mind Centre, University of Sydney, NSW, Australia
| | - Loren Mowszowski
- Parkinson’s Disease Research Clinic, Brain and Mind Centre, University of Sydney, NSW, Australia
- Healthy Brain Ageing Program, School of Psychology, 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
| | - Courtney C. Walton
- Parkinson’s Disease Research Clinic, Brain and Mind Centre, University of Sydney, NSW, Australia
| | - Sharon L. Naismith
- Parkinson’s Disease Research Clinic, Brain and Mind Centre, University of Sydney, NSW, Australia
- Healthy Brain Ageing Program, School of Psychology, 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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Shine JM, Koyejo O, Bell PT, Gorgolewski KJ, Gilat M, Poldrack RA. Estimation of dynamic functional connectivity using Multiplication of Temporal Derivatives. Neuroimage 2015; 122:399-407. [DOI: 10.1016/j.neuroimage.2015.07.064] [Citation(s) in RCA: 132] [Impact Index Per Article: 14.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2015] [Revised: 05/01/2015] [Accepted: 07/23/2015] [Indexed: 11/29/2022] Open
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Gilat M, Shine JM, Walton CC, O'Callaghan C, Hall JM, Lewis SJG. Brain activation underlying turning in Parkinson's disease patients with and without freezing of gait: a virtual reality fMRI study. NPJ Parkinsons Dis 2015; 1:15020. [PMID: 28725687 PMCID: PMC5516618 DOI: 10.1038/npjparkd.2015.20] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/21/2015] [Revised: 07/21/2015] [Accepted: 08/24/2015] [Indexed: 11/09/2022]
Abstract
BACKGROUND Freezing of gait is a debilitating symptom affecting many patients with Parkinson's disease (PD), causing severe immobility and decreased quality of life. Turning is known to be the most common trigger for freezing and also causes the highest rates of falls. However, the pathophysiological basis for these effects is not well understood. METHODS This study used a virtual reality paradigm in combination with functional magnetic resonance imaging to explore the neural correlates underlying turning in 17 PD patients with freezing of gait (FOG) and 10 PD patients without FOG while off their dopaminergic medication. Participants used foot pedals to navigate a virtual environment, which allowed for blood oxygen level-dependent (BOLD) responses and footstep latencies to be compared between periods of straight "walking" and periods of turning through 90°. BOLD data were then analyzed using a mixed effects analysis. RESULTS Within group similarities revealed that overall, PD patients with freezing relied heavily on cortical control to enable effective stepping with increased visual cortex activation during turning. Between groups differences showed that when turning, patients with freezing preferentially activated inferior frontal regions that have been implicated in the recruitment of a putative stopping network. In addition, freezers failed to activate premotor and superior parietal cortices. Finally, increased task-based functional connectivity was found in subcortical regions associated with gait and stopping within the freezers group during turning. CONCLUSIONS These findings suggest that an increased propensity towards stopping in combination with reduced sensorimotor integration may underlie the neurobiology of freezing of gait during turning.
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Affiliation(s)
- Moran Gilat
- Parkinson's Disease Research Clinic, Brain and Mind Research Institute, The University of Sydney, Sydney, NSW, Australia
| | - James M Shine
- Parkinson's Disease Research Clinic, Brain and Mind Research Institute, The University of Sydney, Sydney, NSW, Australia.,Department of Psychology, Stanford University, Stanford, CA, USA
| | - Courtney C Walton
- Parkinson's Disease Research Clinic, Brain and Mind Research Institute, The University of Sydney, Sydney, NSW, Australia
| | - Claire O'Callaghan
- Parkinson's Disease Research Clinic, Brain and Mind Research Institute, The University of Sydney, Sydney, NSW, Australia.,Department of Psychology, Behavioural and Clinical Neuroscience Institute, University of Cambridge, Cambridge, UK
| | - Julie M Hall
- Parkinson's Disease Research Clinic, Brain and Mind Research Institute, The University of Sydney, Sydney, NSW, Australia.,School of Social Sciences and Psychology, University of Western Sydney, Sydney, NSW, Australia
| | - Simon J G Lewis
- Parkinson's Disease Research Clinic, Brain and Mind Research Institute, The University of Sydney, Sydney, NSW, Australia
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Affiliation(s)
- Julie M Hall
- Parkinson's Disease Research Clinic, Brain and Mind Research Institute, The University of Sydney, NSW, Australia
| | - Moran Gilat
- Parkinson's Disease Research Clinic, Brain and Mind Research Institute, The University of Sydney, NSW, Australia
| | - Simon J G Lewis
- Parkinson's Disease Research Clinic, Brain and Mind Research Institute, The University of Sydney, NSW, Australia
| | - James M Shine
- Parkinson's Disease Research Clinic, Brain and Mind Research Institute, The University of Sydney, NSW, Australia
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Bell PT, Gilat M, O'Callaghan C, Copland DA, Frank MJ, Lewis SJG, Shine JM. Dopaminergic basis for impairments in functional connectivity across subdivisions of the striatum in Parkinson's disease. Hum Brain Mapp 2015; 36:1278-91. [PMID: 25425542 PMCID: PMC6869546 DOI: 10.1002/hbm.22701] [Citation(s) in RCA: 60] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2014] [Revised: 10/20/2014] [Accepted: 11/17/2014] [Indexed: 01/29/2023] Open
Abstract
The pathological hallmark of Parkinson's disease is the degeneration of dopaminergic nigrostriatal neurons, leading to depletion of striatal dopamine. Recent neuroanatomical work has identified pathways for communication across striatal subdivisions, suggesting that the striatum provides a platform for integration of information across parallel corticostriatal circuits. The aim of this study was to investigate whether dopaminergic dysfunction in Parkinson's disease was associated with impairments in functional connectivity across striatal subdivisions, which could potentially reflect reduced integration across corticostriatal circuits. Utilizing resting-state functional magnetic resonance imaging (fMRI), we analyzed functional connectivity in 39 patients with Parkinson's disease, both "on" and "off" their regular dopaminergic medications, along with 40 age-matched healthy controls. Our results demonstrate widespread impairments in connectivity across subdivisions of the striatum in patients with Parkinson's disease in the "off" state. The administration of dopaminergic medication significantly improved connectivity across striatal subdivisions in Parkinson's disease, implicating dopaminergic deficits in the pathogenesis of impaired striatal interconnectivity. In addition, impaired striatal interconnectivity in the Parkinson's disease "off" state was associated with pathological decoupling of the striatum from the thalamic and sensorimotor (SM) networks. Specifically, we found that although the strength of striatal interconnectivity was positively correlated with both (i) the strength of internal thalamic connectivity, and (ii) the strength of internal SM connectivity, in both healthy controls and the Parkinson's disease "on" state, these relationships were absent in Parkinson's disease when in the "off" state. Taken together our findings emphasize the central role of dopamine in integrated striatal function and the pathological consequences of striatal dopamine denervation in Parkinson's disease.
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Affiliation(s)
- Peter T Bell
- Brain and Mind Research Institute, The University of Sydney, Sydney, NSW, Australia; University of Queensland Centre for Clinical Research, University of Queensland, Brisbane, QLD, Australia
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