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Ong YQ, Lee J, Chu SY, Chai SC, Gan KB, Ibrahim NM, Barlow SM. Oral-diadochokinesis between Parkinson's disease and neurotypical elderly among Malaysian-Malay speakers. Int J Lang Commun Disord 2024. [PMID: 38451114 DOI: 10.1111/1460-6984.13025] [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] [Subscribe] [Scholar Register] [Received: 08/08/2023] [Accepted: 02/09/2024] [Indexed: 03/08/2024]
Abstract
BACKGROUND Parkinson's disease (PD) has an impact on speech production, manifesting in various ways including alterations in voice quality, challenges in articulating sounds and a decrease in speech rate. Numerous investigations have been conducted to ascertain the oral-diadochokinesis (O-DDK) rate in individuals with PD. However, the existing literature lacks exploration of such O-DDK rates in Malaysia and does not provide consistent evidence regarding the advantage of real-word repetition. AIMS To explore the effect of gender, stimuli type and PD status and their interactions on the O-DDK rates among Malaysian-Malay speakers. METHODS & PROCEDURES O-DDK performance of 62 participants (29 individuals with PD and 33 healthy elderly) using a non-word ('pataka'), a Malay real-word ('patahkan') and an English real-word ('buttercake') was audio recorded. The number of syllables produced in 8 s was counted. A hierarchical linear modelling was performed to investigate the effects of stimuli type (non-word, Malay real-word, English real-word), PD status (yes, no), gender (male, female) and their interactions on the O-DDK rate. The model accounted for participants' age as well as the nesting of repeated measurements within participants, thereby providing unbiased estimates of the effects. OUTCOMES & RESULTS The stimuli effect was significant (p < 0.0001). Malay real-word showed the lowest O-DDK rate (5.03 ± 0.11 syllables/s), followed by English real-word (5.25 ± 0.11 syllables/s) and non-word (5.42 ± 0.11 syllables/s). Individuals with PD showed a significantly lower O-DDK rate compared to healthy elderly (4.73 ± 0.15 syllables/s vs. 5.74 ± 0.14 syllables/s, adjusted p < 0.001). A subsequent analysis indicated that the O-DDK rate declined in a quadratic pattern. However, neither gender nor age effects were observed. Additionally, no significant two-way interactions were found between stimuli type, PD status and gender (all p > 0.05). Therefore, the choice of stimuli type has no or only limited effect considering the use of O-DDK tests in clinical practice for diagnostic purposes. CONCLUSIONS & IMPLICATIONS The observed slowness in O-DDK among individuals with PD can be attributed to the impact of the movement disorder, specifically bradykinesia, on the physiological aspects of speech production. Speech-language pathologists can gain insights into the impact of PD on speech production and tailor appropriate intervention strategies to address the specific needs of individuals with PD according to disease stages. WHAT THIS PAPER ADDS What is already known on this subject The observed slowness in O-DDK rates among individuals with PD may stem from the movement disorder's effects on the physiological aspects of speech production, particularly bradykinesia. However, there is a lack of consistent evidence regarding the influence of real-word repetition and how O-DDK rates vary across different PD stages. What this study adds to existing knowledge The O-DDK rates decline in a quadratic pattern as the PD progresses. The research provides insights into the advantage of real-word repetition in assessing O-DDK rates, with Malay real-word showing the lowest O-DDK rate, followed by English real-word and non-word. What are the potential or actual clinical implications of this work? Speech-language pathologists can better understand the evolving nature of speech motor impairments as PD progresses. This insight enables them to design targeted intervention strategies that are sensitive to the specific needs and challenges associated with each PD stage. This finding can guide clinicians in selecting appropriate assessment tools for evaluating speech motor function in PD patients.
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Affiliation(s)
- Ying Qian Ong
- Centre for Healthy Ageing and Wellness (H-CARE), Faculty of Health Sciences, Speech Sciences Programme, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
| | - Jaehoon Lee
- Department of Educational Psychology, Leadership, and Counseling, Texas Tech University, Lubbock, Texas, USA
| | - Shin Ying Chu
- Centre for Healthy Ageing and Wellness (H-CARE), Faculty of Health Sciences, Speech Sciences Programme, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
| | - Siaw Chui Chai
- Centre for Rehabilitation & Special Needs Studies, Faculty of Health Sciences, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
| | - Kok Beng Gan
- Department of Electrical, Electronic and Systems Engineering, Faculty of Engineering and Built Environment, Universiti Kebangsaan Malaysia, Bangi, Malaysia
| | - Norlinah Mohamed Ibrahim
- Department of Medicine, Hospital Canselor Tuanku Muhriz, Faculty of Medicine, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
| | - Steven M Barlow
- Special Education & Communication Disorders, Biomedical Engineering, Center for Brain, Biology, Behavior, University of Nebraska-Lincoln, Lincoln, Nebraska, USA
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Sujith P, Arjunan P, Iype T, Natarajan V. Correlation Between Depression and Quality of Life Among Patients With Parkinson's Disease: An Analytical Cross-Sectional Study. Cureus 2024; 16:e54736. [PMID: 38523931 PMCID: PMC10960943 DOI: 10.7759/cureus.54736] [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] [Accepted: 02/22/2024] [Indexed: 03/26/2024] Open
Abstract
Introduction Parkinson's disease (PD) is a progressive complex degenerative disorder characterised by several motor and non-motor symptoms that result in disability and deterioration of the patient's quality of life (QOL). Depression is the most common non-motor symptom that may severely alter the QOL. The objective of this study was to examine the correlation between depression and QOL among patients with PD who received treatment from a movement disorder clinic of a tertiary care teaching hospital in South India. Methods This was an analytical cross-sectional study conducted among 220 PD patients who received treatment from a movement disorder clinic of a tertiary care teaching hospital in South India. The participants aged between 40 and 80 years, who can comprehend Malayalam or English and were clinically diagnosed with PD according to United Kingdom PD Society Brain Bank criteria were included in the study. Depression was assessed using the Hospital Anxiety and Depression Scale, motor function using the Movement Disorder Society Unified Parkinson's Disease Rating Scale Part III, and the quality of life was assessed using the Parkinson's Disease Questionnaire 39. Results The results of this study showed that there was a significant positive correlation between depression and QOL (r=0.699, p<0.01) among patients with PD who received treatment from a tertiary care teaching hospital. The correlation with domains of QOL also identified that depression was significantly correlated with all domains of QOL and more to the emotional domain of QOL (r=0.799, p<0.01). Conclusion Depression is the most common neuropsychiatric condition in PD and the most important determinant of QOL. Depression may occur at any stage of PD and can significantly impact the QOL of patients and their caregivers. Hence it should be recognized early and managed by pharmacological and nonpharmacological measures to improve the QOL.
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Affiliation(s)
- Priya Sujith
- Nursing, Government College of Nursing, Thiruvananthapuram, IND
- Nursing, Sri Ramachandra Institute of Higher Education and Research, Chennai, IND
| | - Porkodi Arjunan
- Medical Surgical Nursing, Sri Ramachandra Institute of Higher Education and Research, Chennai, IND
| | - Thomas Iype
- Neurology, Medical College Thiruvananthapuram, Thiruvananthapuram, IND
| | - Venkatesh Natarajan
- Physiotherapy, Sri Ramachandra Institute of Higher Education and Research, Chennai, IND
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Paparella G, De Riggi M, Cannavacciuolo A, Costa D, Birreci D, Passaretti M, Angelini L, Colella D, Guerra A, Berardelli A, Bologna M. Interhemispheric imbalance and bradykinesia features in Parkinson's disease. Brain Commun 2024; 6:fcae020. [PMID: 38370448 PMCID: PMC10873583 DOI: 10.1093/braincomms/fcae020] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2023] [Revised: 12/14/2023] [Accepted: 01/25/2024] [Indexed: 02/20/2024] Open
Abstract
In patients with Parkinson's disease, the connectivity between the two primary motor cortices may be altered. However, the correlation between asymmetries of abnormal interhemispheric connections and bradykinesia features has not been investigated. Furthermore, the potential effects of dopaminergic medications on this issue remain largely unclear. The aim of the present study is to investigate the interhemispheric connections in Parkinson's disease by transcranial magnetic stimulation and explore the potential relationship between interhemispheric inhibition and bradykinesia feature asymmetry in patients. Additionally, we examined the impact of dopaminergic therapy on neurophysiological and motor characteristics. Short- and long-latency interhemispheric inhibition was measured in 18 Parkinson's disease patients and 18 healthy controls, bilaterally. We also assessed the corticospinal and intracortical excitability of both primary motor cortices. We conducted an objective analysis of finger-tapping from both hands. Correlation analyses were performed to explore potential relationships among clinical, transcranial magnetic stimulation and kinematic data in patients. We found that short- and long-latency interhemispheric inhibition was reduced (less inhibition) from both hemispheres in patients than controls. Compared to controls, finger-tapping movements in patients were slower, more irregular, of smaller amplitudes and characterized by a progressive amplitude reduction during movement repetition (sequence effect). Among Parkinson's disease patients, the degree of short-latency interhemispheric inhibition imbalance towards the less affected primary motor cortex correlated with the global clinical motor scores, as well as with the sequence effect on the most affected hand. The greater the interhemispheric inhibition imbalance towards the less affected hemisphere (i.e. less inhibition from the less to the most affected primary motor cortex than that measured from the most to the less affected primary motor cortex), the more severe the bradykinesia in patients. In conclusion, the inhibitory connections between the two primary motor cortices in Parkinson's disease are reduced. The interhemispheric disinhibition of the primary motor cortex may have a role in the pathophysiology of specific bradykinesia features in patients, i.e. the sequence effect.
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Affiliation(s)
- Giulia Paparella
- IRCCS Neuromed, Pozzilli, IS 86077, Italy
- Department of Human Neurosciences, Sapienza, University of Rome, Rome 00185, Italy
| | - Martina De Riggi
- Department of Human Neurosciences, Sapienza, University of Rome, Rome 00185, Italy
| | | | - Davide Costa
- Department of Human Neurosciences, Sapienza, University of Rome, Rome 00185, Italy
| | - Daniele Birreci
- Department of Human Neurosciences, Sapienza, University of Rome, Rome 00185, Italy
| | | | | | - Donato Colella
- Department of Human Neurosciences, Sapienza, University of Rome, Rome 00185, Italy
| | - Andrea Guerra
- Parkinson and Movement Disorders Unit, Study Center for Neurodegeneration (CESNE), Department of Neuroscience, University of Padua, Padua 35121, Italy
- Padova Neuroscience Center (PNC), University of Padua, Padua 35131, Italy
| | - Alfredo Berardelli
- IRCCS Neuromed, Pozzilli, IS 86077, Italy
- Department of Human Neurosciences, Sapienza, University of Rome, Rome 00185, Italy
| | - Matteo Bologna
- IRCCS Neuromed, Pozzilli, IS 86077, Italy
- Department of Human Neurosciences, Sapienza, University of Rome, Rome 00185, Italy
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Brissenden JA, Scerbak T, Albin RL, Lee TG. Motivational Vigor in Parkinson's Disease Requires the Short and Long Duration Response to Levodopa. Mov Disord 2024; 39:76-84. [PMID: 38062630 PMCID: PMC10842158 DOI: 10.1002/mds.29659] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2023] [Revised: 09/27/2023] [Accepted: 10/26/2023] [Indexed: 02/01/2024] Open
Abstract
BACKGROUND Impaired movement vigor (bradykinesia) is a cardinal feature of Parkinson's disease (PD) and hypothesized to result from abnormal motivational processes-impaired motivation-vigor coupling. Dopamine replacement therapy (DRT) improves bradykinesia, but the response to DRT is multifaceted, comprising a short-duration response (SDR) and a long-duration response (LDR) only manifesting with chronic treatment. Prior experiments assessing motivation-vigor coupling in PD used chronically treated subjects, obscuring the roles of the SDR and LDR. METHODS To disambiguate the SDR and LDR, 11 de novo PD subjects (6 male [M]:5 female [F]; mean age, 67) were studied before treatment, after an acute levodopa (l-dopa) dose, and in both the practical "off" (LDR) and "on" (LDR + SDR) states after chronic stable treatment. At each visit, subjects were characterized with a standard battery including the Movement Disorder Society-Sponsored Revision of the Unified Parkinson's Disease Rating Scale (MDS-UPDRS) and an incentivized joystick task to assess motor performance in response to varying rewards. RESULTS l-Dopa induced a robust SDR and LDR, with further improvement in the combined SDR + LDR state. At baseline, after acute treatment (SDR), and after LDR induction, subjects did not exhibit the normal increase in movement speed with increasing reward. Only in the combined SDR + LDR state was there restoration of motivation-vigor coupling. CONCLUSIONS Although consistent with prior results in chronically treated PD subjects, the significant improvement in motor performance observed with the SDR and LDR suggests that bradykinesia is not solely secondary to deficient modulation of motivational processes. © 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)
- James A Brissenden
- Department of Psychology, University of Michigan, Ann Arbor, Michigan, USA
| | - Teresa Scerbak
- Department of Neurology, University of Michigan, Ann Arbor, Michigan, USA
| | - Roger L Albin
- Department of Neurology, University of Michigan, Ann Arbor, Michigan, USA
- Neurology Service and Geriatric Research Education and Clinical Center, Veteran Affairs Ann Arbor Healthcare System, Ann Arbor, Michigan, USA
| | - Taraz G Lee
- Department of Psychology, University of Michigan, Ann Arbor, Michigan, USA
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Kim MJ, Shi Y, Lee J, Salimpour Y, Anderson WS, Mills KA. Anatomical substrates and connectivity for bradykinesia motor features in Parkinson's disease after subthalamic nucleus deep brain stimulation. Brain Commun 2023; 5:fcad337. [PMID: 38130840 PMCID: PMC10733813 DOI: 10.1093/braincomms/fcad337] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2023] [Revised: 10/29/2023] [Accepted: 12/12/2023] [Indexed: 12/23/2023] Open
Abstract
Parkinsonian bradykinesia is rated using a composite scale incorporating the slowed frequency of repetitive movements, decrement amplitude and arrhythmicity. Differential localization of these movement components within the basal ganglia will drive the development of more personalized network-targeted symptomatic therapies. In this study, using an optical motion sensor, we evaluated the amplitude and frequency of hand movements during a grasping task with subthalamic nucleus deep brain stimulation 'on' or 'off' in 15 patients with Parkinson's disease. The severity of bradykinesia was assessed blindly using the Unified Parkinson's Disease Rating Part III scale. The volumes of activated tissue of each subject were estimated where changes in amplitude and frequency were mapped to identify distinct anatomical substrates of each component in the subthalamic nucleus. The volumes of activated tissue were used to seed a normative functional connectome to generate connectivity maps associated with amplitude and frequency changes. Deep brain stimulation-induced change in amplitude was negatively correlated with a change in Unified Parkinson's Disease Rating Part III scale for right (r = -0.65, P < 0.05) and left hand grasping scores (r = -0.63, P < 0.05). The change in frequency was negatively correlated with amplitude for both right (r = -0.63, P < 0.05) and left hands (r = -0.57, P < 0.05). The amplitude and frequency changes were represented as a spatial gradient with overlapping and non-overlapping regions spanning the anteromedial-posterolateral axis of the subthalamic nucleus. Whole-brain correlation maps between functional connectivity and motor changes were also inverted between amplitude and frequency changes. Deep brain stimulation-associated changes in frequency and amplitude were topographically and distinctly represented both locally in the subthalamic nucleus and in whole-brain functional connectivity.
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Affiliation(s)
- Min Jae Kim
- Movement Disorders Division, Department of Neurology, Johns Hopkins School of Medicine, 600 N. Wolfe Street, Baltimore, MD 21287, USA
- Department of Neurosurgery, Johns Hopkins School of Medicine, 600 N. Wolfe Street, Baltimore, MD 21287, USA
- Department of Biomedical Engineering, Johns Hopkins University, 3400 N. Charles St, Baltimore, MD 21218, USA
| | - Yiwen Shi
- Movement Disorders Division, Department of Neurology, Johns Hopkins School of Medicine, 600 N. Wolfe Street, Baltimore, MD 21287, USA
| | - Jasmine Lee
- Movement Disorders Division, Department of Neurology, Johns Hopkins School of Medicine, 600 N. Wolfe Street, Baltimore, MD 21287, USA
| | - Yousef Salimpour
- Department of Neurosurgery, Johns Hopkins School of Medicine, 600 N. Wolfe Street, Baltimore, MD 21287, USA
| | - William S Anderson
- Department of Neurosurgery, Johns Hopkins School of Medicine, 600 N. Wolfe Street, Baltimore, MD 21287, USA
- Department of Biomedical Engineering, Johns Hopkins University, 3400 N. Charles St, Baltimore, MD 21218, USA
| | - Kelly A Mills
- Movement Disorders Division, Department of Neurology, Johns Hopkins School of Medicine, 600 N. Wolfe Street, Baltimore, MD 21287, USA
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Sigcha L, Polvorinos-Fernández C, Costa N, Costa S, Arezes P, Gago M, Lee C, López JM, de Arcas G, Pavón I. Monipar: movement data collection tool to monitor motor symptoms in Parkinson's disease using smartwatches and smartphones. Front Neurol 2023; 14:1326640. [PMID: 38148984 PMCID: PMC10750794 DOI: 10.3389/fneur.2023.1326640] [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: 10/23/2023] [Accepted: 11/21/2023] [Indexed: 12/28/2023] Open
Abstract
Introduction Parkinson's disease (PD) is a neurodegenerative disorder commonly characterized by motor impairments. The development of mobile health (m-health) technologies, such as wearable and smart devices, presents an opportunity for the implementation of clinical tools that can support tasks such as early diagnosis and objective quantification of symptoms. Objective This study evaluates a framework to monitor motor symptoms of PD patients based on the performance of standardized exercises such as those performed during clinic evaluation. To implement this framework, an m-health tool named Monipar was developed that uses off-the-shelf smart devices. Methods An experimental protocol was conducted with the participation of 21 early-stage PD patients and 7 healthy controls who used Monipar installed in off-the-shelf smartwatches and smartphones. Movement data collected using the built-in acceleration sensors were used to extract relevant digital indicators (features). These indicators were then compared with clinical evaluations performed using the MDS-UPDRS scale. Results The results showed moderate to strong (significant) correlations between the clinical evaluations (MDS-UPDRS scale) and features extracted from the movement data used to assess resting tremor (i.e., the standard deviation of the time series: r = 0.772, p < 0.001) and data from the pronation and supination movements (i.e., power in the band of 1-4 Hz: r = -0.662, p < 0.001). Conclusion These results suggest that the proposed framework could be used as a complementary tool for the evaluation of motor symptoms in early-stage PD patients, providing a feasible and cost-effective solution for remote and ambulatory monitoring of specific motor symptoms such as resting tremor or bradykinesia.
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Affiliation(s)
- Luis Sigcha
- Instrumentation and Applied Acoustics Research Group (I2A2), ETSI Industriales, Universidad Politécnica de Madrid, Madrid, Spain
- ALGORITMI Research Center, School of Engineering, University of Minho, Guimarães, Portugal
| | - Carlos Polvorinos-Fernández
- Instrumentation and Applied Acoustics Research Group (I2A2), ETSI Industriales, Universidad Politécnica de Madrid, Madrid, Spain
| | - Nélson Costa
- ALGORITMI Research Center, School of Engineering, University of Minho, Guimarães, Portugal
| | - Susana Costa
- ALGORITMI Research Center, School of Engineering, University of Minho, Guimarães, Portugal
| | - Pedro Arezes
- ALGORITMI Research Center, School of Engineering, University of Minho, Guimarães, Portugal
| | - Miguel Gago
- Life and Health Sciences Research Institute (ICVS), School of Medicine, University of Minho, Braga, Portugal
| | - Chaiwoo Lee
- AgeLab, Massachusetts Institute of Technology, Cambridge, MA, United States
| | - Juan Manuel López
- Escuela Técnica Superior de Ingeniería y Sistemas de Telecomunicación (ETSIT), Universidad Politécnica de Madrid, Madrid, Spain
| | - Guillermo de Arcas
- Instrumentation and Applied Acoustics Research Group (I2A2), ETSI Industriales, Universidad Politécnica de Madrid, Madrid, Spain
| | - Ignacio Pavón
- Instrumentation and Applied Acoustics Research Group (I2A2), ETSI Industriales, Universidad Politécnica de Madrid, Madrid, Spain
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Singh M, Prakash P, Kaur R, Sowers R, Brašić JR, Hernandez ME. A Deep Learning Approach for Automatic and Objective Grading of the Motor Impairment Severity in Parkinson's Disease for Use in Tele-Assessments. Sensors (Basel) 2023; 23:9004. [PMID: 37960703 PMCID: PMC10650884 DOI: 10.3390/s23219004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/20/2023] [Revised: 10/18/2023] [Accepted: 10/25/2023] [Indexed: 11/15/2023]
Abstract
Wearable sensors provide a tool for at-home monitoring of motor impairment progression in neurological conditions such as Parkinson's disease (PD). This study examined the ability of deep learning approaches to grade the motor impairment severity in a modified version of the Movement Disorders Society-sponsored revision of the Unified Parkinson's Disease Rating Scale (MDS-UPDRS) using low-cost wearable sensors. We hypothesized that expanding training datasets with motion data from healthy older adults (HOAs) and initializing classifiers with weights learned from unsupervised pre-training would lead to an improvement in performance when classifying lower vs. higher motor impairment relative to a baseline deep learning model (XceptionTime). This study evaluated the change in classification performance after using expanded training datasets with HOAs and transferring weights from unsupervised pre-training compared to a baseline deep learning model (XceptionTime) using both upper extremity (finger tapping, hand movements, and pronation-supination movements of the hands) and lower extremity (toe tapping and leg agility) tasks consistent with the MDS-UPDRS. Overall, we found a 12.2% improvement in accuracy after expanding the training dataset and pre-training using max-vote inference on hand movement tasks. Moreover, we found that the classification performance improves for every task except toe tapping after the addition of HOA training data. These findings suggest that learning from HOA motion data can implicitly improve the representations of PD motion data for the purposes of motor impairment classification. Further, our results suggest that unsupervised pre-training can improve the performance of motor impairment classifiers without any additional annotated PD data, which may provide a viable solution for a widely deployable telemedicine solution.
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Affiliation(s)
- Mehar Singh
- Computer Science and Engineering Division, University of Michigan, Ann-Arbor, MI 48109, USA;
- Department of Computer Science, University of Illinois Urbana-Champaign, Urbana, IL 61801, USA
| | - Prithvi Prakash
- School of Information Sciences, University of Illinois Urbana-Champaign, Champaign, IL 61820, USA;
| | - Rachneet Kaur
- Department of Industrial and Enterprise Systems Engineering, University of Illinois Urbana-Champaign, Urbana, IL 61801, USA; (R.K.); (R.S.)
| | - Richard Sowers
- Department of Industrial and Enterprise Systems Engineering, University of Illinois Urbana-Champaign, Urbana, IL 61801, USA; (R.K.); (R.S.)
| | - James Robert Brašić
- Section of High Resolution Brain Positron Emission Tomography Imaging, Division of Nuclear Medicine and Molecular Imaging, Russell H. Morgan Department of Radiology and Radiological Sciences, The Johns Hopkins University School of Medicine, Baltimore, MD 21205, USA
- Department of Behavioral Health, New York City Health + Hospitals/Bellevue, 462 First Avenue, New York, NY 10016, USA
- Department of Psychiatry, New York University Grossman School of Medicine, New York University Langone Health, New York University, 550 First Avenue, New York, NY 10016, USA
| | - Manuel Enrique Hernandez
- Neuroscience Program, Beckman Institute, College of Liberal Arts & Sciences, University of Illinois Urbana-Champaign, Urbana, IL 61801, USA
- Department of Biomedical and Translational Sciences, University of Illinois Urbana-Champaign, Urbana, IL 61801, USA
- Department of Kinesiology and Community Health, University of Illinois Urbana-Champaign, Urbana, IL 61801, USA
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Sujith P, Arjunan P, Iype T, Natarajan V. Depression in Patients With Parkinson's Disease: A Hospital-Based Cross-Sectional Study. Cureus 2023; 15:e47214. [PMID: 38022066 PMCID: PMC10653116 DOI: 10.7759/cureus.47214] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/17/2023] [Indexed: 12/01/2023] Open
Abstract
INTRODUCTION Depression, a common non-motor symptom in Parkinson's disease (PD), is often underdiagnosed and can significantly impact the quality of life (QOL) and treatment outcomes. Specific disease-related factors and non-specific factors may contribute to depression, and these factors should be identified early to plan the appropriate interventions that promote positive mood. The study aimed to assess the prevalence of depression in PD patients and to find out the factors associated with depression among patients with PD attending the neurology OPD of a tertiary care teaching hospital in Trivandrum. METHODS A cross-sectional study was conducted at the neurology OPD of Government Medical College Hospital, Trivandrum, from December 2021 to February 2023. We included patients with PD diagnosed according to the United Kingdom PD Society Brain Bank criteria. We collected data from 220 patients with PD by interview technique. Hospital Anxiety and Depression Scale (HADS) was used to assess depression and anxiety in this study. Staging and the severity of the motor symptoms were assessed using the Hoehn and Yahr scale and the Movement Disorder Society Unified Parkinson's Disease Rating Scale Part III (MDS UPDRS Part III), respectively. RESULTS Among 220 patients with PD, 31.8% (95% CI: 4.36-5.40) had depression. The non-specific variables, such as education, living arrangements, and gender, and disease-specific variables, such as the severity of motor symptoms (MDS UPDRS Part III score) and the Hoehn and Yahr staging of PD, had a statistically significant association with depression. Logistic regression analysis showed that the severity of motor symptoms (OR=2.69, p=0.004)) and female gender (OR=1.830, p= 0.05) were the independent factors associated with depression. CONCLUSION Depression is a common non-motor symptom of PD that is often underdiagnosed and undertreated and can significantly impact the QOL of patients and their caregivers. Hence, it should be identified early and managed by pharmacological and non-pharmacological strategies.
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Affiliation(s)
- Priya Sujith
- Medical Surgical Nursing, Government College of Nursing, Trivandrum, IND
- Nursing, Sri Ramachandra Institute of Higher Education and Research, Chennai, IND
| | - Porkodi Arjunan
- Medical Surgical Nursing, Sri Ramachandra Institute of Higher Education and Research, Chennai, IND
| | - Thomas Iype
- Neurology, Government Medical College, Trivandrum, IND
| | - Venkatesh Natarajan
- Physiotherapy, Sri Ramachandra Institute of Higher Education and Research, Chennai, IND
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Asbeutah S, Ponomareva G, Molla M, Shah S. Behind the Mask of Parkinsonism: A Case Report and Literature Review on Progressive Supranuclear Palsy. Cureus 2023; 15:e47313. [PMID: 38022214 PMCID: PMC10656750 DOI: 10.7759/cureus.47313] [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] [Accepted: 10/19/2023] [Indexed: 12/01/2023] Open
Abstract
Progressive supranuclear palsy (PSP) is a neurodegenerative condition that typically emerges in adulthood and does not exhibit any familial inheritance pattern. PSP is characterized by gradual stiffness in the central body, an inability to move the gaze upward voluntarily, postural instability, and a decline in cognitive function linked to frontal lobe dysfunction. Clinical assessment reveals a variety of findings, and cases of PSP frequently go unnoticed or are incorrectly diagnosed as other conditions. Notably, prominent neurotransmitter-related changes in PSP involve damage to the dopaminergic nigrostriatal pathway and cholinergic impairment in multiple regions. We hereby present a case of a 71-year-old female patient whose medical journey unfolds as a perplexing riddle. Despite the collective expertise of several physicians, she found herself bearing the weight of a misdiagnosis ascribed to Parkinson's Disease (PD) erroneously. She initially presented with recurring falls due to postural instability and bradykinesia, which progressed such that she became dependent on a walking aid. A comprehensive physical examination revealed indicators consistent with PSP.
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Affiliation(s)
| | - Galina Ponomareva
- Neurology, University College Dublin School of Medicine, Dublin, IRL
| | - Meron Molla
- Internal Medicine, Pomeranian Medical University, Szczecin, POL
| | - Shruti Shah
- Internal Medicine, Byramjee Jeejeebhoy (BJ) Medical College, Pune, IND
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10
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Stegemöller EL, Berg R, Warnecke A, Hammer M. Comparison of auditory cueing in toe tapping and gait in persons with Parkinson's disease. Front Hum Neurosci 2023; 17:1197247. [PMID: 37727863 PMCID: PMC10505663 DOI: 10.3389/fnhum.2023.1197247] [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: 03/30/2023] [Accepted: 08/21/2023] [Indexed: 09/21/2023] Open
Abstract
Introduction Much research has examined the relationship between bradykinesia and gait impairment in persons with Parkinson's disease (PD). Specifically, impairments in repetitive movements of the upper extremity have been associated with freezing of gait. Studies examining lower extremity repetitive movements are limited. Moreover, the use of external cueing has been a treatment strategy for both bradykinesia and gait, but information on how cues should be used is lacking. The purpose of this study was to compare the effects of auditory cueing on one side versus both sides for bilateral repetitive toe tapping and gait, and to determine if there was a relationship between toe tapping and gait. We hypothesize that there will be no difference between the cueing conditions, but that there will be a significant association between repetitive toe tapping performance and gait performance. Methods Twenty-seven persons with PD completed a toe tapping task in which the more affected side was cued at 70 beats per minute (BPM), the less affected side was cued at 70 BPM, and both sides were cued at 140 BPM. The same cueing conditions were completed for the gait task. Inter movement interval and amplitude data was collected and analyzed for the toe tapping task. Stance time, swing time, step length, and step width were collected and analyzed for the gait task. Results Results revealed a significant difference in movement performance between the single side cueing conditions and both sides cued condition for inter movement interval (toe tapping), stance time (gait), step length (gait), and step width (gait). Moreover, results revealed a significant association between inter movement interval and stance time and step length. Discussion These results would suggest that cueing both sides is better than only one side and that there is a relationship between toe tapping and gait performance when both sides are cued in persons with PD. This study adds to the literature exploring possible shared mechanisms between bradykinesia and gait in persons with PD.
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11
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Cavallieri F, Di Rauso G, Gessani A, Budriesi C, Fioravanti V, Contardi S, Menozzi E, Pinto S, Moro E, Antonelli F, Valzania F. A study on the correlations between acoustic speech variables and bradykinesia in advanced Parkinson's disease. Front Neurol 2023; 14:1213772. [PMID: 37533469 PMCID: PMC10393249 DOI: 10.3389/fneur.2023.1213772] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2023] [Accepted: 06/15/2023] [Indexed: 08/04/2023] Open
Abstract
Background Very few studies have assessed the presence of a possible correlation between speech variables and limb bradykinesia in patients with Parkinson's disease (PD). The objective of this study was to find correlations between different speech variables and upper extremity bradykinesia under different medication conditions in advanced PD patients. Methods Retrospective data were collected from a cohort of advanced PD patients before and after an acute levodopa challenge. Each patient was assessed with a perceptual-acoustic analysis of speech, which included several quantitative parameters [i.e., maximum phonation time (MPT) and intensity (dB)]; the Unified Parkinson's Disease Rating Scale (UPDRS) (total scores, subscores, and items); and a timed test (a tapping test for 20 s) to quantify upper extremity bradykinesia. Pearson's correlation coefficient was applied to find correlations between the different speech variables and the tapping rate. Results A total of 53 PD patients [men: 34; disease duration: 10.66 (SD 4.37) years; age at PD onset: 49.81 years (SD 6.12)] were included. Levodopa intake increased the MPT of sustained phonation (p < 0.01), but it reduced the speech rate (p = 0.05). In the defined-OFF condition, MPT of sustained phonation positively correlated with both bilateral mean (p = 0.044, r-value:0.299) and left (p = 0.033, r-value:0.314) tapping. In the defined-ON condition, the MPT correlated positively with bilateral mean tapping (p = 0.003), left tapping (p = 0.003), and right tapping (p = 0.008). Conclusion This study confirms the presence of correlations between speech acoustic variables and upper extremity bradykinesia in advanced PD patients. These findings suggest common pathophysiological mechanisms.
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Affiliation(s)
- Francesco Cavallieri
- Neurology Unit, Neuromotor and Rehabilitation Department, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Giulia Di Rauso
- Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy
- Neurology, Neuroscience Head Neck Department, Azienda Ospedaliero-Universitaria di Modena, Modena, Italy
| | - Annalisa Gessani
- Neurology, Neuroscience Head Neck Department, Azienda Ospedaliero-Universitaria di Modena, Modena, Italy
| | - Carla Budriesi
- Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy
- Neurology, Neuroscience Head Neck Department, Azienda Ospedaliero-Universitaria di Modena, Modena, Italy
| | - Valentina Fioravanti
- Neurology Unit, Neuromotor and Rehabilitation Department, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Sara Contardi
- IRCCS Istituto delle Scienze Neurologiche di Bologna, Neurologia e Rete Stroke Metropolitana, Ospedale Maggiore, Bologna, Italy
| | - Elisa Menozzi
- Department of Clinical and Movement Neurosciences, UCL Queen Square Institute of Neurology, London, United Kingdom
| | - Serge Pinto
- Aix Marseille Univ, CNRS, LPL, Aix-en-Provence, France
| | - Elena Moro
- Grenoble Alpes University, Division of Neurology, Centre Hospitalier Universitaire de Grenoble, Grenoble Institute of Neuroscience, Grenoble, France
| | - Francesca Antonelli
- Neurology, Neuroscience Head Neck Department, Azienda Ospedaliero-Universitaria di Modena, Modena, Italy
| | - Franco Valzania
- Neurology Unit, Neuromotor and Rehabilitation Department, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
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12
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Habets JGV, Spooner RK, Mathiopoulou V, Feldmann LK, Busch JL, Roediger J, Bahners BH, Schnitzler A, Florin E, Kühn AA. A First Methodological Development and Validation of ReTap: An Open-Source UPDRS Finger Tapping Assessment Tool Based on Accelerometer-Data. Sensors (Basel) 2023; 23:s23115238. [PMID: 37299968 DOI: 10.3390/s23115238] [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] [Subscribe] [Scholar Register] [Received: 04/28/2023] [Revised: 05/24/2023] [Accepted: 05/29/2023] [Indexed: 06/12/2023]
Abstract
Bradykinesia is a cardinal hallmark of Parkinson's disease (PD). Improvement in bradykinesia is an important signature of effective treatment. Finger tapping is commonly used to index bradykinesia, albeit these approaches largely rely on subjective clinical evaluations. Moreover, recently developed automated bradykinesia scoring tools are proprietary and are not suitable for capturing intraday symptom fluctuation. We assessed finger tapping (i.e., Unified Parkinson's Disease Rating Scale (UPDRS) item 3.4) in 37 people with Parkinson's disease (PwP) during routine treatment follow ups and analyzed their 350 sessions of 10-s tapping using index finger accelerometry. Herein, we developed and validated ReTap, an open-source tool for the automated prediction of finger tapping scores. ReTap successfully detected tapping blocks in over 94% of cases and extracted clinically relevant kinematic features per tap. Importantly, based on the kinematic features, ReTap predicted expert-rated UPDRS scores significantly better than chance in a hold out validation sample (n = 102). Moreover, ReTap-predicted UPDRS scores correlated positively with expert ratings in over 70% of the individual subjects in the holdout dataset. ReTap has the potential to provide accessible and reliable finger tapping scores, either in the clinic or at home, and may contribute to open-source and detailed analyses of bradykinesia.
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Affiliation(s)
- Jeroen G V Habets
- Movement Disorder and Neuromodulation Unit, Department of Neurology, Charité Universitaetsmedizin Berlin, 10117 Berlin, Germany
| | - Rachel K Spooner
- Institute of Clinical Neuroscience and Medical Psychology, Medical Faculty, Heinrich Heine University Düsseldorf, 40225 Düsseldorf, Germany
| | - Varvara Mathiopoulou
- Movement Disorder and Neuromodulation Unit, Department of Neurology, Charité Universitaetsmedizin Berlin, 10117 Berlin, Germany
| | - Lucia K Feldmann
- Movement Disorder and Neuromodulation Unit, Department of Neurology, Charité Universitaetsmedizin Berlin, 10117 Berlin, Germany
| | - Johannes L Busch
- Movement Disorder and Neuromodulation Unit, Department of Neurology, Charité Universitaetsmedizin Berlin, 10117 Berlin, Germany
| | - Jan Roediger
- Movement Disorder and Neuromodulation Unit, Department of Neurology, Charité Universitaetsmedizin Berlin, 10117 Berlin, Germany
| | - Bahne H Bahners
- Institute of Clinical Neuroscience and Medical Psychology, Medical Faculty, Heinrich Heine University Düsseldorf, 40225 Düsseldorf, Germany
- Department of Neurology, Center for Movement Disorders and Neuromodulation, Medical Faculty, Heinrich-Heine University Düsseldorf, 40225 Düsseldorf, Germany
| | - Alfons Schnitzler
- Institute of Clinical Neuroscience and Medical Psychology, Medical Faculty, Heinrich Heine University Düsseldorf, 40225 Düsseldorf, Germany
- Department of Neurology, Center for Movement Disorders and Neuromodulation, Medical Faculty, Heinrich-Heine University Düsseldorf, 40225 Düsseldorf, Germany
| | - Esther Florin
- Institute of Clinical Neuroscience and Medical Psychology, Medical Faculty, Heinrich Heine University Düsseldorf, 40225 Düsseldorf, Germany
| | - Andrea A Kühn
- Movement Disorder and Neuromodulation Unit, Department of Neurology, Charité Universitaetsmedizin Berlin, 10117 Berlin, Germany
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13
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Guerra A, Colella D, Cannavacciuolo A, Giangrosso M, Paparella G, Fabbrini G, Berardelli A, Bologna M. Short-term plasticity of the motor cortex compensates for bradykinesia in Parkinson's disease. Neurobiol Dis 2023; 182:106137. [PMID: 37120094 DOI: 10.1016/j.nbd.2023.106137] [Citation(s) in RCA: 6] [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: 03/16/2023] [Revised: 04/14/2023] [Accepted: 04/24/2023] [Indexed: 05/01/2023] Open
Abstract
Patients with Parkinson's disease (PD) show impaired short-term potentiation (STP) mechanisms in the primary motor cortex (M1). However, the role played by this neurophysiological abnormality in bradykinesia pathophysiology is unknown. In this study, we used a multimodal neuromodulation approach to test whether defective STP contributes to bradykinesia. We evaluated STP by measuring motor-evoked potential facilitation during 5 Hz-repetitive transcranial magnetic stimulation (rTMS) and assessed repetitive finger tapping movements through kinematic techniques. Also, we used transcranial alternating current stimulation (tACS) to drive M1 oscillations and experimentally modulate bradykinesia. STP was assessed during tACS delivered at beta (β) and gamma (γ) frequency, and during sham-tACS. Data were compared to those recorded in a group of healthy subjects. In PD, we found that STP was impaired during sham- and γ-tACS, while it was restored during β-tACS. Importantly, the degree of STP impairment was associated with the severity of movement slowness and amplitude reduction. Moreover, β-tACS-related improvements in STP were linked to changes in movement slowness and intracortical GABA-A-ergic inhibition during stimulation, as assessed by short-interval intracortical inhibition (SICI). Patients with prominent STP amelioration had greater SICI reduction (cortical disinhibition) and less slowness worsening during β-tACS. Dopaminergic medications did not modify β-tACS effects. These data demonstrate that abnormal STP processes are involved in bradykinesia pathophysiology and return to normal levels when β oscillations increase. STP changes are likely mediated by modifications in GABA-A-ergic intracortical circuits and may represent a compensatory mechanism against β-induced bradykinesia in PD.
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Affiliation(s)
- Andrea Guerra
- IRCCS Neuromed, Pozzilli, IS 86077, Italy; Department of Human Neurosciences, Sapienza University of Rome, Rome 00185, Italy
| | - Donato Colella
- Department of Human Neurosciences, Sapienza University of Rome, Rome 00185, Italy
| | | | | | | | - Giovanni Fabbrini
- IRCCS Neuromed, Pozzilli, IS 86077, Italy; Department of Human Neurosciences, Sapienza University of Rome, Rome 00185, Italy
| | - Alfredo Berardelli
- IRCCS Neuromed, Pozzilli, IS 86077, Italy; Department of Human Neurosciences, Sapienza University of Rome, Rome 00185, Italy
| | - Matteo Bologna
- IRCCS Neuromed, Pozzilli, IS 86077, Italy; Department of Human Neurosciences, Sapienza University of Rome, Rome 00185, Italy.
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14
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Williams S, Wong D, Alty JE, Relton SD. Parkinsonian Hand or Clinician's Eye? Finger Tap Bradykinesia Interrater Reliability for 21 Movement Disorder Experts. J Parkinsons Dis 2023:JPD223256. [PMID: 37092233 DOI: 10.3233/jpd-223256] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/25/2023]
Abstract
BACKGROUND Bradykinesia is considered the fundamental motor feature of Parkinson's disease (PD). It is central to diagnosis, monitoring, and research outcomes. However, as a clinical sign determined purely by visual judgement, the reliability of humans to detect and measure bradykinesia remains unclear. OBJECTIVE To establish interrater reliability for expert neurologists assessing bradykinesia during the finger tapping test, without cues from additional examination or history. METHODS 21 movement disorder neurologists rated finger tapping bradykinesia, by Unified Parkinson's Disease Rating Scale (MDS-UPDRS) and Modified Bradykinesia Rating Scale (MBRS), in 133 videos of hands: 73 from 39 people with idiopathic PD, 60 from 30 healthy controls. Each neurologist rated 30 randomly-selected videos. 19 neurologists were also asked to judge whether the hand was PD or control. We calculated intraclass correlation coefficients (ICC) for absolute agreement and consistency of MDS-UPDRS ratings, using standard linear and cumulative linked mixed models. RESULTS There was only moderate agreement for finger tapping MDS-UPDRS between neurologists, ICC 0.53 (standard linear model) and 0.65 (cumulative linked mixed model). Among control videos, 53% were rated > 0 by MDS-UPDRS, and 24% were rated as bradykinesia by MBRS subscore combination. Neurologists correctly identified PD/control status in 70% of videos, without strictly following bradykinesia presence/absence. CONCLUSION Even experts show considerable disagreement about the level of bradykinesia on finger tapping, and frequently see bradykinesia in the hands of those without neurological disease. Bradykinesia is to some extent a phenomenon in the eye of the clinician rather than simply the hand of the person with PD.
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Affiliation(s)
- Stefan Williams
- Leeds Institute of Health Science, University of Leeds, Leeds, UK
- Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - David Wong
- Centre for Health Informatics, University of Manchester, Manchester, UK
| | - Jane E Alty
- Leeds Teaching Hospitals NHS Trust, Leeds, UK
- Wicking Dementia Research and Education Centre, University of Tasmania, Hobart, Tasmania, Australia
| | - Samuel D Relton
- Leeds Institute of Health Science, University of Leeds, Leeds, UK
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15
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Bologna M, Espay AJ, Fasano A, Paparella G, Hallett M, Berardelli A. Redefining Bradykinesia. Mov Disord 2023; 38:551-557. [PMID: 36847357 PMCID: PMC10387192 DOI: 10.1002/mds.29362] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2022] [Revised: 01/31/2023] [Accepted: 02/06/2023] [Indexed: 03/01/2023] Open
Affiliation(s)
- Matteo Bologna
- Department of Human Neurosciences, Sapienza University of Rome, Rome, Italy
- IRCCS Neuromed, Pozzilli, Italy
| | - Alberto J. Espay
- Gardner Family Center for Parkinson’s Disease and Movement Disorders, Department of Neurology, University of Cincinnati, Cincinnati, Ohio, USA
| | - Alfonso Fasano
- Edmond J. Safra Program in Parkinson’s Disease, Morton and Gloria Shulman Movement Disorders Clinic, Toronto Western Hospital, UHN, Toronto, Ontario, Canada
- Division of Neurology, University of Toronto, Toronto, Ontario, Canada
- Krembil Brain Institute, Toronto, Ontario, Canada
| | | | - Mark Hallett
- Human Motor Control Section, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, Maryland, USA
| | - Alfredo Berardelli
- Department of Human Neurosciences, Sapienza University of Rome, Rome, Italy
- IRCCS Neuromed, Pozzilli, Italy
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16
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Kim MJ, Shi Y, Lee J, Salimpour Y, Anderson WS, Mills KA. Anatomical Substrates and Connectivity for Parkinson's Disease Bradykinesia Components after STN-DBS. medRxiv 2023:2023.03.02.23286704. [PMID: 36945427 PMCID: PMC10029041 DOI: 10.1101/2023.03.02.23286704] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/11/2023]
Abstract
Background Parkinsonian bradykinesia is rated using a composite scale incorporating slowed frequency of repetitive movements, decrement amplitude, and arrhythmicity. Differential localization of these movement components within basal ganglia would drive the development of more personalized network-targeted symptomatic therapies. Methods Using an optical motion sensor, amplitude and frequency of hand movements during grasping task were evaluated with subthalamic nucleus (STN)-Deep Brain Stimulation (DBS) "on" or "off" in 15 patients with Parkinson's disease (PD). The severity of bradykinesia was assessed blindly using the MDS-UPDRS Part-III scale. Volumes of activated tissue (VAT) of each subject were estimated where changes in amplitude and frequency were mapped to identify distinct anatomical substrates of each component in the STN. VATs were used to seed a normative functional connectome to generate connectivity maps associated with amplitude and frequency changes. Results STN-DBS-induced change in amplitude was negatively correlated with change in MDS-UPDRS-III right (r = -0.65, p < 0.05) and left hand grasping scores (r = -0.63, p < 0.05). The change in frequency was negatively correlated with amplitude for both right (r = -0.63, p < 0.05) and left hand (r = -0.57, p < 0.05). The amplitude and frequency changes were represented as a spatial gradient with overlapping and non-overlapping regions spanning the dorsolateral-ventromedial axis of the STN. Whole-brain correlation maps between functional connectivity and motor changes were also inverted between amplitude and frequency changes. Conclusion DBS-associated changes in frequency and amplitude were topographically and distinctly represented both locally in STN and in whole-brain functional connectivity.
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Affiliation(s)
- Min Jae Kim
- Movement Disorders Division, Department of Neurology, Johns Hopkins School of Medicine, Baltimore, MD, USA
- Department of Neurosurgery, Johns Hopkins School of Medicine, Baltimore, MD, USA
- Department of Biomedical Engineering, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Yiwen Shi
- Movement Disorders Division, Department of Neurology, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Jasmine Lee
- Movement Disorders Division, Department of Neurology, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Yousef Salimpour
- Department of Neurosurgery, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - William S. Anderson
- Department of Neurosurgery, Johns Hopkins School of Medicine, Baltimore, MD, USA
- Department of Biomedical Engineering, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Kelly A. Mills
- Movement Disorders Division, Department of Neurology, Johns Hopkins School of Medicine, Baltimore, MD, USA
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17
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Marsili L, Duque KR, Gregor N, Abdelghany E, Abanto J, Duker AP, Hagen MC, Espay AJ, Bologna M. Bradykinesia in Neurodegenerative Disorders: A Blinded Video Analysis of Pathology-Proven Cases. Mov Disord 2023; 38:496-501. [PMID: 36707401 DOI: 10.1002/mds.29330] [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: 10/10/2022] [Revised: 12/28/2022] [Accepted: 01/09/2023] [Indexed: 01/29/2023] Open
Abstract
BACKGROUND Bradykinesia is a cardinal feature in parkinsonisms. No study has assessed the differential features of bradykinesia in patients with pathology-proven synucleinopathies and tauopathies. OBJECTIVE We examined whether bradykinesia features (speed, amplitude, rhythm, and sequence effect) may differ between pathology-proven synucleinopathies and tauopathies. METHODS Forty-two cases who underwent autopsy were included and divided into synucleinopathies (Parkinson's disease and dementia with Lewy bodies) and tauopathies (progressive supranuclear palsy). Two raters blinded to the diagnosis retrospectively scored the Movement Disorders Society-Unified Parkinson's Disease Rating Scale Part III and Modified Bradykinesia Rating Scale on standardized videotaped neurological examinations. Bradykinesia scores were compared using the Mann-Whitney test and logistic regression models to adjust for disease duration. RESULTS Demographic and clinical parameters were similar between synucleinopathies and tauopathies. There were no differences between speed, amplitude, rhythm, and sequence effect in synucleinopathies and tauopathies in unadjusted comparisons and adjusted models (all P > 0.05). CONCLUSIONS Clinical bradykinesia features do not distinguish the underlying neuropathology in neurodegenerative parkinsonisms. © 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)
- Luca Marsili
- Gardner Family Center for Parkinson's Disease and Movement Disorders, Department of Neurology, University of Cincinnati, Cincinnati, Ohio, USA
| | - Kevin R Duque
- Gardner Family Center for Parkinson's Disease and Movement Disorders, Department of Neurology, University of Cincinnati, Cincinnati, Ohio, USA
| | - Nathan Gregor
- Gardner Family Center for Parkinson's Disease and Movement Disorders, Department of Neurology, University of Cincinnati, Cincinnati, Ohio, USA
| | - Elhusseini Abdelghany
- Gardner Family Center for Parkinson's Disease and Movement Disorders, Department of Neurology, University of Cincinnati, Cincinnati, Ohio, USA
| | - Jesus Abanto
- Gardner Family Center for Parkinson's Disease and Movement Disorders, Department of Neurology, University of Cincinnati, Cincinnati, Ohio, USA
| | - Andrew P Duker
- Gardner Family Center for Parkinson's Disease and Movement Disorders, Department of Neurology, University of Cincinnati, Cincinnati, Ohio, USA
| | - Matthew C Hagen
- Department of Pathology, University of Cincinnati, Cincinnati, Ohio, USA
| | - Alberto J Espay
- Gardner Family Center for Parkinson's Disease and Movement Disorders, Department of Neurology, University of Cincinnati, Cincinnati, Ohio, USA
| | - Matteo Bologna
- Department of Human Neurosciences, Sapienza University of Rome, Rome, Italy
- IRCCS Neuromed, Pozzilli, Italy
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18
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Readman MR, Crawford TJ, Linkenauger SA, Bek J, Poliakoff E. Motor imagery vividness and symptom severity in Parkinson's disease. J Neuropsychol 2023; 17:180-192. [PMID: 36229225 PMCID: PMC10946738 DOI: 10.1111/jnp.12293] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2022] [Revised: 09/12/2022] [Accepted: 09/13/2022] [Indexed: 11/28/2022]
Abstract
Motor imagery (MI), the mental simulation of movement in the absence of overt motor output, has demonstrated potential as a technique to support rehabilitation of movement in neurological conditions such as Parkinson's disease (PD). Existing evidence suggests that MI is largely preserved in PD, but previous studies have typically examined global measures of MI and have not considered the potential impact of individual differences in symptom presentation on MI. The present study investigated the influence of severity of overall motor symptoms, bradykinesia and tremor on MI vividness scores in 44 individuals with mild to moderate idiopathic PD. Linear mixed effects modelling revealed that imagery modality and the severity of left side bradykinesia significantly influenced MI vividness ratings. Consistent with previous findings, participants rated visual motor imagery (VMI) to be more vivid than kinesthetic motor imagery (KMI). Greater severity of left side bradykinesia (but not right side bradykinesia) predicted increased vividness of KMI, while tremor severity and overall motor symptom severity did not predict vividness of MI. The specificity of the effect of bradykinesia to the left side may reflect greater premorbid vividness for the dominant (right) side or increased attention to more effortful movements on the left side of the body resulting in more vivid motor imagery.
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Affiliation(s)
| | | | | | - Judith Bek
- Centre for Motor Control, Faculty of Kinesiology & Physical Education, University of Toronto, Toronto, ON, Canada
- Division of Psychology, Communication and Human Neuroscience, School of Health Sciences., University of Manchester, Manchester, UK
| | - Ellen Poliakoff
- Division of Psychology, Communication and Human Neuroscience, School of Health Sciences., University of Manchester, Manchester, UK
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19
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Lofredi R, Scheller U, Mindermann A, Feldmann LK, Krauss JK, Saryyeva A, Schneider GH, Kühn AA. Pallidal Beta Activity Is Linked to Stimulation-Induced Slowness in Dystonia. Mov Disord 2023. [PMID: 36807626 DOI: 10.1002/mds.29347] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2022] [Accepted: 01/30/2023] [Indexed: 02/22/2023] Open
Abstract
BACKGROUND Pallidal deep brain stimulation (DBS) effectively alleviates symptoms in dystonia patients, but may induce movement slowness as a side-effect. In Parkinson's disease, hypokinetic symptoms have been associated with increased beta oscillations (13-30 Hz). We hypothesize that this pattern is symptom-specific, thus accompanying DBS-induced slowness in dystonia. METHODS In 6 dystonia patients, pallidal rest recordings with a sensing-enabled DBS device were performed and tapping speed was assessed using marker-less pose estimation over 5 time points following cessation of DBS. RESULTS After cessation of pallidal stimulation, movement speed increased over time (P < 0.01). A linear mixed-effects model revealed that pallidal beta activity explained 77% of the variance in movement speed across patients (P = 0.01). CONCLUSIONS The association between beta oscillations and slowness across disease entities provides further evidence for symptom-specific oscillatory patterns in the motor circuit. Our findings might help DBS therapy improvements, as DBS-devices able to adapt to beta oscillations are already commercially available. © 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)
- Roxanne Lofredi
- Department of Neurology, Movement Disorders and Neuromodulation Unit, Charité - Universitätsmedizin Berlin, Berlin, Germany.,Berlin Institute of Health, Berlin, Germany
| | - Ute Scheller
- Department of Neurology, Movement Disorders and Neuromodulation Unit, Charité - Universitätsmedizin Berlin, Berlin, Germany.,Department of Neurology, Georg-August-Universität Göttingen, Göttingen, Germany
| | - Aurika Mindermann
- Department of Neurology, Movement Disorders and Neuromodulation Unit, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Lucia K Feldmann
- Department of Neurology, Movement Disorders and Neuromodulation Unit, Charité - Universitätsmedizin Berlin, Berlin, Germany.,Berlin Institute of Health, Berlin, Germany
| | - Joachim K Krauss
- Department of Neurosurgery, Medizinische Hochschule Hannover, Hannover, Germany
| | - Assel Saryyeva
- Department of Neurosurgery, Medizinische Hochschule Hannover, Hannover, Germany
| | - Gerd-Helge Schneider
- Department of Neurosurgery, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Andrea A Kühn
- Department of Neurology, Movement Disorders and Neuromodulation Unit, Charité - Universitätsmedizin Berlin, Berlin, Germany.,Exzellenzcluster - NeuroCure, Charité - Universitätsmedizin Berlin, Berlin, Germany
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20
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Panyakaew P, Duangjino K, Kerddonfag A, Ploensin T, Piromsopa K, Kongkamol C, Bhidayasiri R. Exploring the Complex Phenotypes of Impaired Finger Dexterity in Mild-to-moderate Stage Parkinson's Disease: A Time-Series Analysis. J Parkinsons Dis 2023; 13:975-988. [PMID: 37574743 PMCID: PMC10578277 DOI: 10.3233/jpd-230029] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 07/17/2023] [Indexed: 08/15/2023]
Abstract
BACKGROUND Impaired dexterity is an early motor symptom in Parkinson's disease (PD) that significantly impacts the daily activity of patients; however, what constitutes complex dexterous movements remains controversial. OBJECTIVE To explore the characteristics of finger dexterity in mild-to-moderate stage PD. METHODS We quantitatively assessed finger dexterity in 48 mild-to-moderate stage PD patients and 49 age-matched controls using a simple alternating two-finger typing test for 15 seconds. Time-series analyses of various kinematic parameters with machine learning were compared between sides and groups. RESULTS Both the more and less affected hands of patients with PD had significantly lower typing frequency and slower typing velocity than the non-dominant and the dominant hands of controls (p = 0.019, p = 0.016, p < 0.001, p < 0.001). The slope of the typing velocity decreased with time, indicating a sequence effect in the PD group. A typing duration of 6 seconds was determined sufficient to discriminate PD patients from controls. Typing error, repetition, and repetition rate were significantly higher in the more affected hands of patients with PD than in the non-dominant hand of controls (p < 0.001, p = 0.03, p < 0.001). The error rate was constant, whereas the repetition rate was steep during the initiation of typing. A predictive model of the more affected hand demonstrated an accuracy of 70% in differentiating PD patients from controls. CONCLUSION Our study demonstrated complex components of impaired finger dexterity in mild-to-moderate stage PD, namely bradykinesia with sequence effects, error, and repetition at the initiation of movement, suggesting that multiple neural networks may be involved in dexterity deficits in PD.
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Affiliation(s)
- Pattamon Panyakaew
- Chulalongkorn Centre of Excellence for Parkinson’s Disease & Related Disorders, Division of Neurology, Department of Medicine, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok, Thailand
| | - Kotchakorn Duangjino
- Chulalongkorn Centre of Excellence for Parkinson’s Disease & Related Disorders, Division of Neurology, Department of Medicine, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok, Thailand
| | - Apiwoot Kerddonfag
- Chulalongkorn Centre of Excellence for Parkinson’s Disease & Related Disorders, Division of Neurology, Department of Medicine, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok, Thailand
| | - Teerit Ploensin
- Department of Computer Engineering, Faculty of Engineering, Chulalongkorn University, Bangkok, Thailand
| | - Krerk Piromsopa
- Department of Computer Engineering, Faculty of Engineering, Chulalongkorn University, Bangkok, Thailand
- Research Group on Applied Computer Engineering Technology for Medicine and Healthcare, Faculty of Engineering, Chulalongkorn University, Bangkok, Thailand
| | - Chanon Kongkamol
- Department of Family and Prevention Medicine, Faculty of Medicine, Prince of Songkla University, Bangkok, Thailand
| | - Roongroj Bhidayasiri
- Chulalongkorn Centre of Excellence for Parkinson’s Disease & Related Disorders, Division of Neurology, Department of Medicine, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok, Thailand
- The Academy of Science, The Royal Society of Thailand, Bangkok, Thailand
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Wilhelm E, Quoilin C, Derosiere G, Paço S, Jeanjean A, Duque J. Corticospinal Suppression Underlying Intact Movement Preparation Fades in Parkinson's Disease. Mov Disord 2022; 37:2396-2406. [PMID: 36121426 DOI: 10.1002/mds.29214] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2022] [Revised: 08/11/2022] [Accepted: 08/17/2022] [Indexed: 01/13/2023] Open
Abstract
BACKGROUND In Parkinson's disease (PD), neurophysiological abnormalities within the primary motor cortex (M1) have been shown to contribute to bradykinesia, but exact modalities are still uncertain. We propose that such motor slowness could involve alterations in mechanisms underlying movement preparation, especially the suppression of corticospinal excitability-called "preparatory suppression"-which is considered to propel movement execution by increasing motor neural gain in healthy individuals. METHODS On two consecutive days, 29 PD patients (on and off medication) and 29 matched healthy controls (HCs) underwent transcranial magnetic stimulation over M1, eliciting motor-evoked potentials (MEPs) in targeted hand muscles, while they were either at rest or preparing a left- or right-hand response in an instructed-delay choice reaction time task. Preparatory suppression was assessed by expressing MEP amplitudes during movement preparation relative to rest. RESULTS Contrary to HCs, PD patients showed a lack of preparatory suppression when the side of the responding hand was analyzed, especially when the latter was the most affected one. This deficit, which did not depend on dopamine medication, increased with disease duration and also tended to correlate with motor impairment, as measured by the Movement Disorder Society Unified Parkinson's Disease Rating Scale, Part III (both total and bradykinesia scores). CONCLUSIONS Our novel findings indicate that preparatory suppression fades in PD, in parallel with worsening motor symptoms, including bradykinesia. Such results suggest that an alteration in this marker of intact movement preparation could indeed cause motor slowness and support its use in future studies on the relation between M1 alterations and motor impairment in PD. © 2022 International Parkinson and Movement Disorder Society.
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Affiliation(s)
- Emmanuelle Wilhelm
- CoActions Lab, Institute of Neuroscience, Université catholique de Louvain, Brussels, Belgium.,Department of Adult Neurology, Saint-Luc University Hospital, Brussels, Belgium
| | - Caroline Quoilin
- CoActions Lab, Institute of Neuroscience, Université catholique de Louvain, Brussels, Belgium
| | - Gerard Derosiere
- CoActions Lab, Institute of Neuroscience, Université catholique de Louvain, Brussels, Belgium
| | - Susana Paço
- NOVA IMS, Universidade Nova de Lisboa, Lisbon, Portugal
| | - Anne Jeanjean
- Department of Adult Neurology, Saint-Luc University Hospital, Brussels, Belgium
| | - Julie Duque
- CoActions Lab, Institute of Neuroscience, Université catholique de Louvain, Brussels, Belgium
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22
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Siokas V, Liampas I, Lyketsos CG, Dardiotis E. Association between Motor Signs and Cognitive Performance in Cognitively Unimpaired Older Adults: A Cross-Sectional Study Using the NACC Database. Brain Sci 2022; 12:1365. [PMID: 36291299 PMCID: PMC9599814 DOI: 10.3390/brainsci12101365] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2022] [Revised: 10/05/2022] [Accepted: 10/06/2022] [Indexed: 11/16/2022] Open
Abstract
Aiming to examine whether specific motor signs are associated with worse performance in specific cognitive domains among cognitively unimpaired (CU) individuals, we performed a cross-sectional analysis of data from the baseline evaluations of older, CU participants from the National Alzheimer's Coordinating Center (NACC) Uniform Data Set. In total, 8149 CU (≥60 years) participants were included. Of these, 905 individuals scored ≥ 2 on at least one of the motor domains of the Unified Parkinson's Disease Rating Scale part III (UPDRSIII). Cognitively impaired individuals, participants with psychiatric disorders and/or under treatment with antipsychotic, anxiolytic, sedative or hypnotic agents were excluded. Nine motor signs were examined: hypophonia, masked facies, resting tremor, action/postural tremor, rigidity, bradykinesia, impaired chair rise, impaired posture/gait and postural instability. Their association with performance on episodic memory, semantic memory, language, attention, processing speed or executive function was assessed using crude and adjusted linear regression models. Individuals with impaired chair rise had worse episodic memory, semantic memory, processing speed and executive function, while those with bradykinesia had worse language, processing speed and executive function. Sensitivity analyses, by excluding participants with cerebrovascular disease or PD, or other Parkinsonism, produced similar results with the exception of the relationship between bradykinesia and language performance.
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Affiliation(s)
- Vasileios Siokas
- Department of Neurology, University Hospital of Larissa, Faculty of Medicine, School of Health Sciences, University of Thessaly, 41100 Larissa, Greece
| | - Ioannis Liampas
- Department of Neurology, University Hospital of Larissa, Faculty of Medicine, School of Health Sciences, University of Thessaly, 41100 Larissa, Greece
| | - Constantine G. Lyketsos
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins School of Medicine, Baltimore, MD 21205, USA
| | - Efthimios Dardiotis
- Department of Neurology, University Hospital of Larissa, Faculty of Medicine, School of Health Sciences, University of Thessaly, 41100 Larissa, Greece
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins School of Medicine, Baltimore, MD 21205, USA
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Jazdarehee A, Huget-Penner S, Pawlowska M. Pseudo-pheochromocytoma due to obstructive sleep apnea: a case report. Endocrinol Diabetes Metab Case Rep 2022; 2022:21-0100. [PMID: 35212265 PMCID: PMC8897593 DOI: 10.1530/edm-21-0100] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2021] [Accepted: 02/02/2022] [Indexed: 11/11/2022] Open
Abstract
SUMMARY Obstructive sleep apnea (OSA) is a condition of intermittent nocturnal upper airway obstruction. OSA increases sympathetic drive which may result in clinical and biochemical features suggestive of pheochromocytoma. We present the case of a 65-year-old male with a 2.9-cm left adrenal incidentaloma on CT, hypertension, symptoms of headache, anxiety and diaphoresis, and persistently elevated 24-h urine norepinephrine (initially 818 nmol/day (89-470)) and normetanephrine (initially 11.2 µmol/day (0.6-2.7)). He was started on prazosin and underwent left adrenalectomy. Pathology revealed an adrenal corticoadenoma with no evidence of pheochromocytoma. Over the next 2 years, urine norepinephrine and normetanephrine remained significantly elevated with no MIBG avid disease. Years later, he was diagnosed with severe OSA and treated with continuous positive airway pressure. Urine testing done once OSA was well controlled revealed complete normalization of urine norepinephrine and normetanephrine with substantial symptom improvement. It was concluded that the patient never had a pheochromocytoma but rather an adrenal adenoma with biochemistry and symptoms suggestive of pheochromocytoma due to untreated severe OSA. Pseudo-pheochromocytoma is a rare presentation of OSA and should be considered on the differential of elevated urine catecholamines and metanephrines in the right clinical setting. LEARNING POINTS Obstructive sleep apnea (OSA) is a common condition among adults. OSA may rarely present as pseudo-pheochromocytoma with symptoms of pallor, palpitations, perspiration, headache, or anxiety. OSA should be considered on the differential of elevated urine catecholamines and metanephrines, especially in patients with negative metaiodobenzylguanidine (MIBG) scan results.
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Key Words
- adolescent/young adult
- adult
- geriatric
- neonatal
- paediatric
- pregnant adult
- female
- male
- american indian or alaska native
- asian - bangladeshi
- asian - chinese
- asian - filipino
- asian - indian
- asian - japanese
- asian - korean
- asian - pakistani
- asian - vietnamese
- asian - other
- black - african
- black - caribbean
- black - other
- hispanic or latino - central american or south american
- hispanic or latino - cuban
- hispanic or latino - dominican
- hispanic or latino - mexican, mexican american, chicano
- hispanic or latino - puerto rican
- hispanic or latino - other
- native hawaiian/other pacific islander
- white
- other
- afghanistan
- aland islands
- albania
- algeria
- american samoa
- andorra
- angola
- anguilla
- antarctica
- antigua and barbuda
- argentina
- armenia
- aruba
- australia
- austria
- azerbaijan
- bahamas
- bahrain
- bangladesh
- barbados
- belarus
- belgium
- belize
- benin
- bermuda
- bhutan
- bolivia
- bosnia and herzegovina
- botswana
- bouvet island
- brazil
- british indian ocean territory
- brunei darussalam
- bulgaria
- burkina faso
- burundi
- cambodia
- cameroon
- canada
- cape verde
- cayman islands
- central african republic
- chad
- chile
- china
- christmas island
- cocos (keeling) islands
- colombia
- comoros
- congo
- congo, the democratic republic of the
- cook islands
- costa rica
- côte d'ivoire
- croatia
- cuba
- cyprus
- czech republic
- denmark
- djibouti
- dominica
- dominican republic
- ecuador
- egypt
- el salvador
- equatorial guinea
- eritrea
- estonia
- ethiopia
- falkland islands (malvinas)
- faroe islands
- fiji
- finland
- france
- french guiana
- french polynesia
- french southern territories
- gabon
- gambia
- georgia
- germany
- ghana
- gibraltar
- greece
- greenland
- grenada
- guadeloupe
- guam
- guatemala
- guernsey
- guinea
- guinea-bissau
- guyana
- haiti
- heard island and mcdonald islands
- holy see (vatican city state)
- honduras
- hong kong
- hungary
- iceland
- india
- indonesia
- iran, islamic republic of
- iraq
- ireland
- isle of man
- israel
- italy
- jamaica
- japan
- jersey
- jordan
- kazakhstan
- kenya
- kiribati
- korea, democratic people's republic of
- korea, republic of
- kuwait
- kyrgyzstan
- lao people's democratic republic
- latvia
- lebanon
- lesotho
- liberia
- libyan arab jamahiriya
- liechtenstein
- lithuania
- luxembourg
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- macedonia, the former yugoslav republic of
- madagascar
- malawi
- malaysia
- maldives
- mali
- malta
- marshall islands
- martinique
- mauritania
- mauritius
- mayotte
- mexico
- micronesia, federated states of
- moldova, republic of
- monaco
- mongolia
- montenegro
- montserrat
- morocco
- mozambique
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- nauru
- nepal
- netherlands
- netherlands antilles
- new caledonia
- new zealand
- nicaragua
- niger
- nigeria
- niue
- norfolk island
- northern mariana islands
- norway
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- palau
- palestinian territory, occupied
- panama
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- pitcairn
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- saint barthélemy
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- solomon islands
- somalia
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- south georgia and the south sandwich islands
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- svalbard and jan mayen
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- sweden
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- syrian arab republic
- taiwan, province of china
- tajikistan
- tanzania, united republic of
- thailand
- timor-leste
- togo
- tokelau
- tonga
- trinidad and tobago
- tunisia
- turkey
- turkmenistan
- turks and caicos islands
- tuvalu
- uganda
- ukraine
- united arab emirates
- united kingdom
- united states
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- uzbekistan
- vanuatu
- vatican city state
- venezuela
- viet nam
- virgin islands, british
- virgin islands, u.s.
- wallis and futuna
- western sahara
- yemen
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- zimbabwe
- maylaysia
- adipose tissue
- adrenal
- bone
- duodenum
- heart
- hypothalamus
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- endothelin
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- epo
- fgf23
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- gastrin
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- glp1
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- gonadotropins
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- hydroxypregnenolone
- igf1
- igf2
- inhibin
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- lh
- melanocyte-stimulating hormone
- melatonin
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- 17-beta-hydroxysteroid dehydrogenase type 3 deficiency
- 3-m syndrome
- 22q11 deletion syndrome
- 49xxxxy syndrome
- abscess
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- adrenal insufficiency
- adrenal salt-wasting crisis
- adrenarche
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- autoimmune polyendocrine syndrome 2
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- bartter syndrome
- bilateral adrenal hyperplasia
- biliary calculi
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- brown tumour
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- casr gene mutation
- catecholamine secreting carotid body paraganglionoma
- cancer-prone syndrome
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- c-cell hyperplasia
- cerebrospinal fluid leakage
- chronic fatigue syndrome
- circadian rhythm sleep disorders
- congenital adrenal hyperplasia
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- congenital hyperinsulinism
- conn's syndrome
- corticotrophic adenoma
- craniopharyngioma
- cretinism
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- denys-drash syndrome
- desynchronosis
- developmental abnormalities
- diabetes - lipoatrophic
- diabetes - mitochondrial
- diabetes - steroid-induced
- diabetes insipidus - dipsogenic
- diabetes insipidus - gestational
- diabetes insipidus - nephrogenic
- diabetes insipidus - neurogenic/central
- diabetes mellitus type 1
- diabetes mellitus type 2
- diabetic foot syndrome
- diabetic hypoglycaemia
- diabetic ketoacidosis
- diabetic muscle infarction
- diabetic nephropathy
- diverticular disease
- donohue syndrome
- down syndrome
- eating disorders
- ectopic acth syndrome
- ectopic cushing's syndrome
- ectopic parathyroid adenoma
- empty sella syndrome
- endometrial cancer
- endometriosis
- eosinophilic myositis
- euthyroid sick syndrome
- familial hypocalciuric hypercalcaemia
- familial dysalbuminaemic hyperthyroxinaemia
- familial euthyroid hyperthyroxinaemia
- fat necrosis
- female athlete triad syndrome
- fetal demise
- fetal macrosomia
- follicular thyroid cancer
- fractures
- frasier syndrome
- friedreich's ataxia
- functional parathyroid cyst
- galactorrhoea
- gastrinoma
- gastritis
- gastrointestinal perforation
- gastrointestinal stromal tumour
- gck mutation
- gender identity disorder
- gestational diabetes mellitus
- giant ovarian cysts
- gigantism
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- glucagonoma
- glucocorticoid remediable aldosteronism
- glycogen storage disease
- goitre
- goitre (multinodular)
- gonadal dysgenesis
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- gonadotrophic adenoma
- gorham's disease
- granuloma
- granulosa cell tumour
- graves' disease
- graves' ophthalmopathy
- growth hormone deficiency (adult)
- growth hormone deficiency (childhood onset)
- gynaecomastia
- hamman's syndrome
- haemorrhage
- hajdu-cheney syndrome
- hashimoto's disease
- hemihypertrophy
- hepatitis c
- hereditary multiple osteochondroma
- hirsutism
- histiocytosis
- huntington's disease
- hürthle cell adenoma
- hyperaldosteronism
- hyperandrogenism
- hypercalcaemia
- hypercalcaemic crisis
- hyperglucogonaemia
- hyperglycaemia
- hypergonadotropic hypogonadism
- hypergonadotropism
- hyperinsulinaemia
- hyperinsulinaemic hypoglycaemia
- hyperkalaemia
- hyperlipidaemia
- hypernatraemia
- hyperosmolar hyperglycaemic state
- hyperparathyroidism (primary)
- hyperparathyroidism (secondary)
- hyperparathyroidism (tertiary)
- hyperpituitarism
- hyperprolactinaemia
- hypersexuality
- hypertension
- hyperthyroidism
- hypoaldosteronism
- hypocalcaemia
- hypoestrogenism
- hypoglycaemia
- hypoglycaemic coma
- hypogonadism
- hypogonadotrophic hypogonadism
- hypoinsulinaemia
- hypokalaemia
- hyponatraemia
- hypoparathyroidism
- hypophosphataemia
- hypophosphatasia
- hypophysitis
- hypopituitarism
- hypothyroidism
- iatrogenic disorder
- idiopathic bilateral adrenal hyperplasia
- idiopathic pituitary hyperplasia
- igg4-related systemic disease
- inappropriate tsh secretion
- incidentaloma
- infertility
- insulin autoimmune syndrome
- insulin resistance
- insulinoma
- intracranial vasospasm
- intrauterine growth retardation
- iodine allergy
- ischaemic heart disease
- kallmann syndrome
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- klinefelter syndrome
- kwashiorkor
- kwashiorkor (marasmic)
- leg ulcer
- laron syndrome
- latent autoimmune diabetes of adults (lada)
- laurence-moon syndrome
- left ventricular hypertrophy
- leukocytoclastic vasculitis
- leydig cell tumour
- lipodystrophy
- lipomatosis
- liver failure
- lung metastases
- luteoma
- lymphadenopathy
- macronodular adrenal hyperplasia
- macronodular hyperplasia
- macroprolactinoma
- marasmus
- maturity onset diabetes of young (mody)
- mccune-albright syndrome
- mckittrick-wheelock syndrome
- medullary thyroid cancer
- meigs syndrome
- membranous nephropathy
- men1
- men2a
- men2b
- men4
- menarche
- meningitis
- menopause
- metabolic acidosis
- metabolic syndrome
- metastatic carcinoma
- metastatic chromaffin cell tumour
- metastatic gastrinoma
- metastatic melanoma
- metastatic tumour
- microadenoma
- microprolactinoma
- motor neurone disease
- myasthenia gravis
- myelolipoma
- myocardial infarction
- myositis
- myotonic dystrophy type 1
- myotonic dystrophy type 2
- myxoedema
- myxoedema coma
- nelson's syndrome
- neonatal diabetes
- nephrolithiasis
- neuroblastoma
- neuroendocrine tumour
- neurofibromatosis
- nodular hyperplasia
- non-functioning pituitary adenoma
- non-hodgkin lymphoma
- non-islet-cell tumour hypoglycaemia
- noonan syndrome
- oculocerebrorenal syndrome
- osteogenesis imperfecta
- osteomalacia
- osteomyelitis
- osteoporosis
- osteoporosis (pregnancy/lactation-associated)
- osteosclerosis
- ovarian cancer
- ovarian dysgenesis
- ovarian hyperstimulation syndrome
- ovarian tumour
- paget's disease
- paget's disease (juvenille)
- pancreatic neuroendocrine tumour
- pancreatitis
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- papillary thyroid cancer
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- parathyroid carcinoma
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- pcos
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- pituitary abscess
- pituitary adenoma
- pituitary apoplexy
- pituitary carcinoma
- pituitary cyst
- pituitary haemorrhage
- pituitary hyperplasia
- pituitary hypoplasia
- pituitary tumour (malignant)
- plurihormonal pituitary adenoma
- poems syndrome
- polycythaemia
- porphyria
- pneumonia
- posterior reversible encephalopathy syndrome
- post-prandial hypoglycaemia
- prader-willi syndrome
- prediabetes
- pre-eclampsia
- pregnancy
- premature ovarian failure
- premenstrual dysphoric disorder
- premenstrual syndrome
- primary hypertrophic osteoarthropathy
- prolactinoma
- prostate cancer
- pseudohypoaldosteronism type 1
- pseudohypoaldosteronism type 2
- pseudohypoparathyroidism
- psychosocial short stature
- puberty (delayed or absent)
- puberty (precocious)
- pulmonary oedema
- quadrantanopia
- rabson-mendenhall syndrome
- rhabdomyolysis
- rheumatoid arthritis
- rickets
- schwannoma
- sellar reossification
- sertoli cell tumour
- sertoli-leydig cell tumour
- sexual development disorders
- sheehan's syndrome
- short stature
- siadh
- small-cell carcinoma
- small intestine neuroendocrine tumour
- solitary fibrous tumour
- solitary sellar plasmacytoma
- somatostatinoma
- somatotrophic adenoma
- squamous cell thyroid carcinoma
- stiff person syndrome
- struma ovarii
- subcutaneous insulin resistance
- systemic lupus erythematosus
- takotsubo cardiomyopathy
- tarts
- testicular cancer
- thecoma
- thyroid adenoma
- thyroid carcinoma
- thyroid cyst
- thyroid dysgenesis
- thyroid fibromatosis
- thyroid hormone resistance syndrome
- thyroid lymphoma
- thyroid nodule
- thyroid storm
- thyroiditis
- thyrotoxicosis
- thyrotrophic adenoma
- traumatic brain injury
- tuberculosis
- tuberous sclerosis complex
- tumour-induced osteomalacia
- turner syndrome
- unilateral adrenal hyperplasia
- ureterolithiasis
- urolithiasis
- von hippel-lindau disease
- wagr syndrome
- waterhouse-friderichsen syndrome
- williams syndrome
- wolcott-rallison syndrome
- wolfram syndrome
- xanthogranulomatous hypophysitis
- xlaad/ipex
- zollinger-ellison syndrome
- abdominal adiposity
- abdominal distension
- abdominal cramp
- abdominal discomfort
- abdominal guarding
- abdominal lump
- abdominal pain
- abdominal tenderness
- abnormal posture
- abdominal wall defects
- abrasion
- acalculia
- accelerated growth
- acne
- acrochorda
- acroosteolysis
- acute stress reaction
- adverse breast development
- aggression
- agitation
- agnosia
- akathisia
- akinesia
- albuminuria
- alcohol intolerance
- alexia
- alopecia
- altered level of consciousness
- amaurosis
- amaurosis fugax
- ambiguous genitalia
- amblyopia
- amenorrhoea
- ameurosis
- amnesia
- amusia
- anasarca
- angiomyxoma
- anhedonia
- anisocoria
- ankle swelling
- anorchia
- anorectal malformations
- anorexia
- anosmia
- anosognosia
- anovulation
- antepartum haemorrhage
- anuria
- anxiety
- apathy
- aphasia
- aphonia
- apnoea
- appendicitis
- appetite increase
- appetite reduction/loss
- apraxia
- aqueductal stenosis
- arteriosclerosis
- arthralgia
- articulation impairment
- ascites
- asperger syndrome
- asphyxia
- asthenia
- astigmatism
- asymptomatic
- ataxia
- atrial fibrillation
- atrial myxoma
- atrophy
- adhd
- autism
- autonomic neuropathy
- avulsion
- babinski's sign
- back pain
- bacteraemia
- behavioural problems
- belching
- bifid scrotum
- biliary colic
- bitemporal hemianopsia
- blindness
- blistering
- bloating
- bloody show
- boil(s)
- bone cyst
- bone fracture(s)
- bone lesions
- bone pain
- bony metastases
- borborygmus
- bowel movements - bleeding
- bowel movements - increased frequency
- bowel movements - pain
- bowel obstruction
- bowel perforation
- brachycephaly
- brachydactyly
- bradycardia
- bradykinesia
- bradyphrenia
- bradypnea
- breast contour change
- breast enlargement
- breast lump
- breast reduction
- breast tenderness
- breastfeeding difficulties
- breathing difficulties
- bronchospasms
- brushfield spots
- bruxism
- buffalo hump
- cachexia
- calcification
- cardiac fibrosis
- cardiac malformations
- cardiac tamponade
- cardiogenic shock
- cardiomegaly
- cardiomyopathy
- cardiopulmonary arrest
- carpal tunnel syndrome
- caruncle - inflammation
- cataplexy
- cataract(s)
- catathrenia
- central obesity
- cerebrospinal fluid rhinorrhoea
- cervical pain
- cheeks - full
- cheiloschisis
- chemosis
- chest pain
- chest pain (pleuritic)
- chest pain (precordial)
- cheyne-stokes respiration
- chills
- cholecystitis
- cholestasis
- chondrocalcinosis
- chordee
- chorea
- choroidal atrophy
- chronic pain
- circulatory collapse
- cirrhosis
- citraturia
- claudication
- clitoromegaly
- cloacal exstrophy
- clonus
- club foot
- clumsiness
- coagulopathy
- coarctation
- coeliac disease
- cognitive problems
- cold intolerance
- collapse
- colour blindness
- coma
- concentration difficulties
- confusion
- congenital heart defect
- conjunctivitis
- constipation
- convulsions
- coordination difficulties
- coughing
- crackles
- cramps
- craniofacial abnormalities
- craniotabes
- cutaneous ischaemia
- cutaneous myxoma
- cutaneous pigmentation
- cyanosis
- dalrymple's sign
- deafness
- deep vein thrombosis
- dehydration
- delayed puberty
- delirium
- dementia
- dental abscess(es)
- dental problems
- depression
- diabetes insipidus
- diabetic neuropathy
- diabetic foot infection
- diabetic foot neuropathy
- diabetic foot ulceration
- diarrhoea
- diplopia
- dizziness
- duodenal atresia
- duplex kidney(s)
- dysarthria
- dysdiadochokinesia
- dysgraphia
- dyslexia
- dyslipidaemia
- dysmenorrhoea
- dyspareunia
- dyspepsia
- dysphagia
- dysphonia
- dysphoria
- dyspnoea
- dystonia
- dysuria
- ear, nose and/or throat infection
- early menarche
- ears - low set
- ears - pinna abnormalities
- ears - small
- ecchymoses
- ectopic ureter
- emotional immaturity
- encopresis
- endometrial hyperplasia
- enlarged bladder
- enlarged prostate
- eosinophilia
- epicanthic fold
- epilepsy
- epistaxis
- erectile dysfunction
- erythema
- euphoria
- eyebrows - bushy
- eyelid retraction
- eyelid swelling
- eyelids - redness
- eyes - almond-shaped
- eyes - dry
- eyes - feeling of grittiness
- eyes - inflammation
- eyes - irritation
- eyes - itching
- eyes - pain (gazing down)
- eyes - pain (gazing up)
- eyes - redness
- eyes - watering
- face - change in appearance
- face - coarse features
- face - numbness
- facial fullness
- facial palsy
- facial plethora
- facial weakness
- facies - abnormal
- facies - hippocratic
- facies - moon
- faecal incontinence
- failure to thrive
- fallopian tube hyperplasia
- fasciculation
- fatigue
- fatigue (post-exertional)
- feet - cold
- feet - increased size
- feet - large
- feet - pain
- feet - small
- fingers - thick
- flaccid paralysis
- flatulence
- flushing
- fontanelles - enlarged
- frontal bossing
- fungating lesion
- fungating mass
- funny turns
- gait abnormality
- gait unsteadiness
- gallbladder calculi
- gallstones
- gangrene
- gastro-oesophageal reflux
- genital oedema
- genu valgum
- genu varum
- gestational diabetes
- glaucoma
- glucose intolerance
- glucosuria
- growth hormone deficiency
- growth retardation
- haematemesis
- haematochezia
- haematoma
- haematuria
- haemoglobinuria
- haemoptysis
- hair - coarse
- hair - dry
- hair - temporal balding
- hairline - low
- hallucination
- hands - enlargement
- hands - large
- hands - single palmar crease
- hands - small
- head - large
- headache
- hearing loss
- heart failure
- heart murmur
- heat intolerance
- height loss
- hemiballismus
- hemianopia
- hemiparesis
- hemispatial neglect
- hepatic cysts
- hepatic metastases
- hepatomegaly
- hidradenitis suppurativa
- high-arched palate
- hip dislocation
- hippocampal dysgenesis
- hirschsprung's disease
- hot flushes
- hydronephrosis
- hypolipidaemia
- hyperactivity
- hyperacusis
- hyperandrogenaemia
- hypercalciuria
- hypercapnea
- hypercholesterolaemia
- hypercortisolaemia
- hyperflexibility
- hyperglucagonaemia
- hyperhidrosis
- hyperhomocysteinaemia
- hypernasal speech
- hyperopia
- hyperoxaluria
- hyperpigmentation
- hyperplasia
- hyperpnoea
- hypersalivation
- hyperseborrhea
- hypersomnia
- hyperthermia
- hypertrichosis
- hypertrophy
- hyperuricaemia
- hyperventilation
- hypoadrenalism
- hypoalbuminaemia
- hypocalciuria
- hypocitraturia
- hypomagnesaemia
- hypopigmentation
- hypoplastic scrotum
- hypopotassaemia
- hypoprolactinaemia
- hyporeflexia
- hyposmia
- hypospadias
- hypotension
- hypothermia
- hypotonia
- hypoventilation
- hypovitaminosis d
- hypovolaemia
- hypovolaemic shock
- hypoxia
- immunodeficiency
- impulsivity
- inattention
- infections
- inflexibility
- insomnia
- instability
- intussusception
- irritability
- ischaemia
- ischuria
- itching
- jaundice
- keratoconus
- ketonuria
- ketotic odour
- kidney dysplasia
- kidney stones
- kyphoscoliosis
- kyphosis
- labioscrotal fold abnormalities
- laceration
- late dentition
- learning difficulties
- leg pain
- legs - increased length
- leukaemia
- leukocytosis
- libido increase
- libido reduction/loss
- lichen sclerosus
- lips - dry
- lips - thin
- little finger - in-curved
- little finger - short
- liver masses
- lordosis
- lordosis (loss of)
- lymphadenectomy
- lymphadenitis
- lymphocytosis
- lymphoedema
- macroglossia
- malaise
- malaise (post-exertional)
- malodorous perspiration
- mania
- marcus gunn pupil
- mastalgia
- meckel's diverticulum
- melena
- menorrhagia
- menstrual disorder
- mesenteric ischaemia
- metabolic alkalosis
- microalbuminuria
- microcephaly
- micrognathia
- micropenis
- milk-alkali syndrome
- miscarriage
- mood changes/swings
- mouth - down-turned
- mouth - small
- movement - limited range of
- mucosal pigmentation
- muscle atrophy
- muscle freezing
- muscle hypertrophy
- muscle rigidity
- myalgia
- myasthaenia
- mydriasis
- myelodysplasia
- myeloma
- myoclonus
- myodesopsia
- myokymia
- myopathy
- myopia
- myosis
- nail clubbing
- nail dystrophy
- nasal obstruction
- nausea
- neck - loose skin (nape)
- neck - short
- neck mass
- neck pain/discomfort
- necrolytic migratory erythema
- necrosis
- nephrocalcinosis
- nephropathy
- neurofibromas
- night terrors
- nipple change
- nipple discharge
- nipple inversion
- nipple retraction
- nipples widely spaced
- nocturia
- normochromic normocytic anaemia
- nose - depressed bridge
- nose - flat bridge
- nose - thickening
- nystagmus
- obsessive-compulsive disorder
- obstetrical haemorrhage
- obstructive sleep apnoea
- odynophagia
- oedema
- oesophageal atresia
- oesophagitis
- oligomenorrhoea
- oliguria
- onychauxis
- oophoritis
- ophthalmoplegia
- optic atrophy
- orbital fat prolapse
- orbital hypertelorism
- orthostatic hypotension
- osteoarthritis
- osteopenia
- otitis media
- ovarian cysts
- ovarian hyperplasia
- palatoschisis
- pallor
- palmar erythema
- palpebral fissure (downslanted)
- palpebral fissure (extended)
- palpebral fissure (reduced)
- palpebral fissure (upslanted)
- palpitations
- pancreatic fibrosis
- pancytopaenia
- panic attacks
- papilloedema
- paraesthesia
- paralysis
- paranoia
- patellar dislocation
- patellar subluxation
- pedal ulceration
- pellagra
- pelvic mass
- pelvic pain
- penile agenesis
- peptic ulcer
- pericardial effusion
- periodontitis
- periosteal bone reactions
- peripheral oedema
- personality change
- pes cavus
- petechiae
- peyronie's disease
- pharyngitis
- philtrum - long
- philtrum - short
- phosphaturia
- photophobia
- photosensitivity
- pleurisy
- poikiloderma
- polydactyly
- polydipsia
- polyphagia
- polyuria
- poor wound healing
- postmenopausal bleeding
- post-nasal drip
- postprandial fullness
- postural instability
- prehypertension
- premature birth
- premature labour
- prenatal growth retardation
- presbyopia
- pretibial myxoedema
- proctalgia fugax
- prognathism
- proptosis
- prosopagnosia
- proteinuria
- pruritus
- pruritus scroti
- pruritus vulvae
- pseudarthrosis
- psoriatic arthritis
- psychiatric problems
- psychomotor retardation
- psychosis
- pterygium colli
- ptosis
- puberty (delayed/absent)
- puberty (early/precocious)
- puffiness
- pulmonary embolism
- purpura
- pyelonephritis
- pyloric stenosis
- pyrexia
- pyrosis
- pyuria
- rash
- rectal pain
- rectorrhagia
- refractory anemia
- reluctance to weight-bear
- renal agenesis
- renal clubbing
- renal colic
- renal cyst
- renal failure
- renal insufficiency
- renal phosphate wasting (isolated)
- renal tubular acidosis
- respiratory failure
- reticulocytosis
- retinitis pigmentosa
- retinopathy
- retrobulbar pain
- retrograde ejaculation
- retroperitoneal fibrosis
- salivary gland swelling
- salpingitis
- salt craving
- salt wasting
- sarcoidosis
- schizophrenia
- scoliosis
- scotoma
- seborrhoeic dermatitis
- seizures
- sensory loss
- sepsis
- septic arthritis
- septic shock
- shivering
- singultus
- sinusitis
- sixth nerve palsy
- skeletal deformity
- skeletal dysplasia
- skin - texture change
- skin infections
- skin necrosis
- skin pigmentation - spotty
- skin thickening
- skin thinning
- sleep apnoea
- sleep difficulties
- sleep disturbance
- sleep hyperhidrosis
- slow growth
- slurred speech
- social difficulties
- soft tissue swelling
- somnambulism
- somniloquy
- somnolence
- sore throat
- spasms
- spastic paraplegia
- spasticity
- speech delay
- spider naevi
- splenomegaly
- sputum production
- steatorrhoea
- stomatitis
- strabismus
- strangury
- striae
- stridor
- stroke
- subfertility
- suicidal ideation
- supraclavicular fat pads
- supranuclear gaze palsy
- sweating
- syncope
- syndactyly
- tachycardia
- tachypnoea
- teeth gapping
- telangiectasias
- telecanthus
- tetraparesis
- t-reflex (absent)
- t-reflex (depressed)
- tetany
- thermodysregulation
- thrombocytopenia
- thrombocytosis
- thrombophilia
- thrush
- tics
- tinnitus
- toe clubbing
- toe deformities
- toes - thick
- toes - widely spaced
- tongue - protruding
- tracheo-oesophageal compression
- tracheo-oesophageal fistula
- tremulousness
- tricuspid insufficiency
- umbilical hernia
- uraemia
- ureter duplex
- uricaemia
- urinary frequency
- urinary incontinence
- urogenital sinus
- urticaria
- uterine hyperplasia
- uterus duplex
- vagina duplex
- vaginal bleeding
- vaginal discharge
- vaginal dryness
- vaginal pain/tenderness
- vaginism
- ventricular fibrillation
- ventricular hypertrophy
- vertigo
- viraemia
- virilisation (abnormal)
- vision - acuity reduction
- vision - blurred
- visual disturbance
- visual field defect
- visual impairment
- visual loss
- vitiligo
- vocal cord paresis
- vomiting
- von graefe's sign
- weight gain
- weight loss
- wheezing
- widened joint space(s)
- xeroderma
- xerostomia
- 3-methoxy 4-hydroxy mandelic acid
- 17-hydroxypregnenolone (urine)
- 17-ketosteroids
- 25-hydroxyvitamin-d3
- 5hiaa
- aberrant adrenal receptors
- acid-base balance
- acth stimulation
- activated partial thromboplastin time
- acyl-ghrelin
- adrenal antibodies
- adrenal function
- adrenal scintigraphy
- adrenal venous sampling
- afp tumour marker
- alanine aminotransferase
- albumin
- albumin to creatinine ratio
- aldosterone (24-hour urine)
- aldosterone (blood)
- aldosterone (plasma)
- aldosterone (serum)
- aldosterone to renin ratio
- alkaline phosphatase
- alkaline phosphatase (bone-specific)
- alpha-fetoprotein
- ammonia
- amniocentesis
- amylase
- angiography
- anion gap
- anti-acetylcholine antibodies
- anticardiolipin antibody
- anti-insulin antibodies
- anti-islet cell antibody
- anti-gh antibodies
- antinuclear antibody
- anti-tyrosine phosphatase antibodies
- asvs
- barium studies
- basal insulin
- base excess
- apolipoprotein h
- beta-hydroxybutyrate
- bicarbonate
- bilirubin
- biopsy
- blood film
- blood pressure
- bmi
- body fat mass
- bone age
- bone biopsy
- bone mineral content
- bone mineral density
- bone mineral density test
- bone scintigraphy
- bone sialoprotein
- bound insulin
- brca1/brca2
- c1np
- c3 complement
- c4 complement
- ca125
- calcifediol
- calcium (serum)
- calcium (urine)
- calcium to creatinine clearance ratio
- carcinoembryonic antigen
- cardiac index
- catecholamines (24-hour urine)
- catecholamines (plasma)
- cd-56
- chemokines
- chest auscultation
- chloride
- chorionic villus sampling
- chromatography
- chromogranin a
- chromosomal analysis
- clomid challenge
- clonidine suppression
- collagen
- colonoscopy
- colposcopy
- continuous glucose monitoring
- core needle biopsy
- corticotropin-releasing hormone stimulation test
- cortisol (9am)
- cortisol (plasma)
- cortisol (midnight)
- cortisol (salivary)
- cortisol (serum)
- cortisol day curve
- cortisol, free (24-hour urine)
- c-peptide (24-hour urine)
- c-peptide (blood)
- c-reactive protein
- creatinine
- creatine kinase
- creatinine (24-hour urine)
- creatinine (serum)
- creatinine clearance
- crh stimulation
- ctpa scan
- ct scan
- c-telopeptide
- cytokines
- deoxypyridinoline
- dexa scan
- dexamethasone suppression
- dexamethasone suppression (high dose)
- dexamethasone suppression (low dose)
- dhea sulphate
- discectomy
- dldl cholesterol
- dmsa scan
- dna sequencing
- domperidone
- down syndrome screening
- ductal lavage
- echocardiogram
- eeg
- electrocardiogram
- electrolytes
- electromyography
- endoscopic ultrasound
- endoscopy
- endosonography
- enzyme immunoassay
- epinephrine (plasma)
- epinephrine (urine)
- erythrocyte sedimentation rate
- estimated glomerular filtration rate
- ethanol ablation
- ewing and clarke autonomic function
- exercise tolerance
- fbc
- ferritin
- fine needle aspiration biopsy
- flow cytometry
- fludrocortisone suppression
- fluticasone-propionate-17-beta carboxylic acid
- fmri
- folate
- ft3
- ft4
- gada
- gallium nitrate
- gallium scan
- gastric biopsy
- genetic analysis
- genitography
- gh day curve
- gh stimulation
- gh suppression
- glp-1
- glp-2
- glucose suppression test
- glucose (blood)
- glucose (blood, fasting)
- glucose (blood, postprandial)
- glucose (urine)
- glucose tolerance
- glucose tolerance (intravenous)
- glucose tolerance (oral)
- glucose tolerance (prolonged)
- gluten sensitivity
- gnrh stimulation
- gonadotrophins
- growth hormone-releasing peptide-2 test
- gut hormones (fasting)
- haematoxylin and eosin staining
- haemoglobin
- haemoglobin a1c
- hcg (serum)
- hcg (urine)
- hcg stimulation
- hdl cholesterol
- hearing test
- heart rate
- hepatic venous sampling with arterial stimulation
- high-sensitivity c-reactive protein
- histopathology
- hla genotyping
- holter monitoring
- homa
- homocysteine
- hyaluronic acid
- hydrocortisone day curve
- hydroxyproline
- hydroxyprogesterone
- hysteroscopy
- igfbp2
- igfbp3
- igg4/igg ratio
- immunocytochemistry
- immunohistochemistry
- immunoglobulins
- immunoglobulin g2
- immunoglobulin g4
- immunoglobulin a
- immunoglobulin m
- immunostaining
- inferior petrosal sinus sampling
- inhibin b
- insulin (fasting)
- insulin suppression
- insulin tissue resistance tests
- insulin tolerance
- intracranial pressure
- irm imaging
- ketones (plasma)
- ketones (urine)
- kidney function
- lactate
- lactate dehydrogenase
- laparoscopy
- laparoscopy and dye
- laparotomy
- ldl cholesterol
- leuprolide acetate stimulation
- leukocyte esterase (urine)
- levothyroxine absorption
- lipase (serum)
- lipid profile
- liquid-based cytology
- liquid chromatography-mass spectrometry
- liver biopsy
- liver function
- lumbar puncture
- lung function testing
- luteinising hormone releasing hormone test
- macroprolactin
- magnesium
- mag3 scan
- mammogram
- mantoux test
- metanephrines (plasma)
- metanephrines (urinary)
- methoxytyramine
- metoclopramide
- metyrapone cortisol day curve
- metyrapone suppression
- metyrapone test dose
- mibg scan
- microarray analysis
- molecular genetic analysis
- mri
- myocardial biopsy
- nerve conduction study
- neuroendocrine markers
- neuron-specific enolase
- norepinephrine
- ntx
- oct
- octreotide scan
- octreotide suppression test
- osmolality
- ovarian venous sampling
- p1np
- palpation
- pap test
- parathyroid scintigraphy
- pentagastrin
- perchlorate discharge
- percutaneous umbilical blood sampling
- peripheral blood film
- pet scan
- ph (blood)
- phosphate (serum)
- phosphate (urine)
- pituitary function
- plasma osmolality
- plasma viscosity
- platelet count
- pneumococcal antigen
- pneumococcal pcr
- polymerase chain reaction
- polysomnography
- porter-silber chromogens
- potassium
- pregnancy test
- proinsulin
- prostate-specific antigen
- protein electrophoresis
- protein fingerprinting
- protein folding analysis
- psychiatric assessment
- psychometric assessment
- pulse oximetry
- pyelography
- pyridinium crosslinks
- quicki
- plasma renin activity
- radioimmunoassay
- radionuclide imaging
- raiu test
- red blood cell count
- renal biopsy
- renin (24-hour urine)
- respiratory status
- renin (blood)
- renin plasma activity
- rheumatoid factor
- salt loading
- sdldl cholesterol
- secretin stimulation
- selective parathyroid venous sampling
- selective transhepatic portal venous sampling
- semen analysis
- serotonin
- serum osmolality
- serum free insulin
- sestamibi scan
- sex hormone binding globulin
- shbg
- skeletal muscle mass
- skin biopsy
- sleep diary
- sodium
- spect scan
- supervised 72-hour fast
- surgical biopsy
- sweat test
- synaptophysin
- systemic vascular resistance index
- tanner scale
- thoracocentesis
- thyroid transcription factor-1
- thyroglobulin
- thyroid antibodies
- thyroid function
- thyroid scintigraphy
- thyroid ultrasonography
- total cholesterol
- total ghrelin
- total t3
- total t4
- trabecular thickness
- transaminase
- transvaginal ultrasound
- trap 5b
- trh stimulation
- triglycerides
- triiodothyronine (t3) suppression
- troponin
- tsh receptor antibodies
- type 3 precollagen
- type 4 collagen
- ultrasound-guided biopsy
- ultrasound scan
- urea and electrolytes
- uric acid (blood)
- uric acid (urine)
- urinalysis
- urinary free cortisol
- urine 24-hour volume
- urine osmolality
- vaginal examination
- vanillylmandelic acid (24-hour urine)
- visual field assessment
- vitamin b12
- vitamin e
- waist circumference
- water deprivation
- water load
- weight
- western blotting
- white blood cell count
- white blood cell differential count
- x-ray
- zinc
- abscess drainage
- acetic acid injection
- adhesiolysis
- adrenalectomy
- amputation
- analgesics
- angioplasty
- arthrodesis
- assisted reproduction techniques
- bariatric surgery
- bilateral salpingo-oophorectomy
- blood transfusion
- bone grafting
- caesarean section
- cardiac transplantation
- cardiac pacemaker
- cataract extraction
- chemoembolisation
- chemotherapy
- chemoradiotherapy
- clitoroplasty
- continuous renal replacement therapy
- contraception
- cordotomy
- counselling
- craniotomy
- cryopreservation
- cryosurgical ablation
- debridement
- dialysis
- diazoxide
- diet
- duodenotomy
- endonasal endoscopic surgery
- exercise
- external fixation
- extracorporeal shock wave lithotripsy
- extraocular muscle surgery
- eye surgery
- eyelid surgery
- fasciotomy
- fluid repletion
- fluid restriction
- gamma knife radiosurgery
- gastrectomy
- gastrostomy
- gender reassignment surgery
- gonadectomy
- heart transplantation
- hormone replacement
- hormone suppression
- hypophysectomy
- hysterectomy
- inguinal orchiectomy
- internal fixation
- intra-cardiac defibrillator
- islet transplantation
- ivf
- kidney transplantation
- laparoscopic adrenalectomy
- laryngoplasty
- laryngoscopy
- laser lithotripsy
- light treatment
- liver transplantation
- lumpectomy
- lymph node dissection
- mastectomy
- molecularly targeted therapy
- neuroendoscopic surgery
- oophorectomy
- orbital decompression
- orbital radiation
- orchidectomy
- orthopaedic surgery
- osteotomy
- ovarian cystectomy
- ovarian diathermy
- oxygen therapy
- pancreas transplantation
- pancreatectomy
- pancreaticoduodenectomy
- parathyroidectomy
- percutaneous adrenal ablation
- percutaneous nephrolithotomy
- pericardiocentesis
- pericardiotomy
- physiotherapy
- pituitary adenomectomy
- plasma exchange
- plasmapheresis
- psychotherapy
- radiofrequency ablation
- radionuclide therapy
- radiotherapy
- reconstruction of genitalia
- resection of tumour
- right-sided hemicolectomy
- salpingo-oophorectomy
- small bowel resection
- speech and language therapy
- spinal surgery
- splenectomy
- stereotactic radiosurgery
- termination of pregnancy
- thymic transplantation
- thyroidectomy
- tracheostomy
- transcranial surgery
- transsphenoidal surgery
- transtentorial surgery
- vaginoplasty
- vagotomy
- 5-alpha-reductase inhibitors
- 17?-estradiol
- abiraterone
- acarbose
- acetazolamide
- acetohexamide
- adalimumab
- albiglutide
- alendronate
- alogliptin
- alpha-blockers
- alphacalcidol
- alpha-glucosidase inhibitors
- amiloride
- amlodipine
- amoxicillin
- anastrozole
- angiotensin-converting enzyme inhibitors
- angiotensin receptor antagonists
- anthracyclines
- antiandrogens
- antibiotics
- antiemetics
- antiepileptics
- antipsychotics
- antithyroid drugs
- antiseptic
- antivirals
- aripiprazole
- aromatase inhibitors
- aspirin
- astragalus membranaceus
- ativan
- atenolol
- atorvastatin
- avp receptor antagonists
- axitinib
- azathioprine
- bendroflumethiazide
- benzodiazepines
- beta-blockers
- betamethasone
- bexlosteride
- bicalutamide
- bisphosphonates
- bleomycin
- botulinum toxin
- bromocriptine
- cabergoline
- cabozantinib
- calcimimetics
- calcitonin (salmon)
- calcium
- calcium carbonate
- calcium chloride
- calcium dobesilate
- calcium edta
- calcium gluconate
- calcium-l-aspartate
- calcium polystyrene sulphonate
- canagliflozin
- capecitabine
- captopril
- carbimazole
- carboplatin
- carbutamide
- carvedilol
- ceftriaxone
- chlorothiazide
- chlorpropamide
- cholecalciferol
- cholinesterase inhibitors
- ciclosporin
- cinacalcet
- cisplatin
- clodronate
- clomifene
- clomiphene citrate
- clopidogrel
- co-cyprindiol
- codeine
- colonic polyps
- combined oral contraceptive pill
- conivaptan
- cortisone acetate
- continuous subcutaneous hydrocortisone infusion
- continuous subcutaneous insulin infusion
- coumadin
- corticosteroids
- cortisol
- cyproterone acetate
- dacarbazine
- danazol
- dapagliflozin
- daunorubicin
- deferiprone
- demeclocycline
- denosumab
- desmopressin
- dexamethasone
- diazepam
- diethylstilbestrol
- digoxin
- diltiazem
- diphenhydramine
- diuretics
- docetaxel
- dopamine agonists
- dopamine antagonists
- dopamine receptor agonists
- doxazosin
- doxepin
- doxorubicin
- dpp4 inhibitors
- dutasteride
- dutogliptin
- eflornithine
- enoxaparin
- empagliflozin
- epinephrine
- epirubicin
- eplerenone
- epristeride
- equilenin
- equilin
- erlotinib
- ethinylestradiol
- etidronate
- etomidate
- etoposide
- everolimus
- exenatide
- fenofibrate
- finasteride
- fluconazole
- fluticasone
- fludrocortisone
- fluorouracil
- fluoxetine
- flutamide
- furosemide
- gaba receptor antagonists
- gefitinib
- gemcitabine
- gemigliptin
- ginkgo biloba
- glibenclamide
- glibornuride
- gliclazide
- glimepiride
- glipizide
- gliquidone
- glisoxepide
- glp1 agonists
- glucose
- glyclopyramide
- gnrh analogue
- gnrh antagonists
- heparin
- hrt (menopause)
- hydrochlorothiazide
- hydrocortisone
- ibandronate
- ibuprofen
- idarubicin
- idebenone
- imatinib
- immunoglobulin therapy
- implanon
- indapamide
- infliximab
- iron supplements
- isoniazid
- insulin aspart
- insulin glargine
- insulin glulisine
- insulin lispro
- interferon
- intrauterine system
- iopanoic acid
- ipilimumab
- ipragliflozin
- irbesartan
- izonsteride
- ketoconazole
- labetalol
- lactulose
- lanreotide
- leuprolide acetate
- levatinib
- levodopa
- levonorgestrel
- levothyroxine
- linagliptin
- liothyronine
- liraglutide
- lithium
- lisinopril
- lixivaptan
- loperamide
- loprazolam
- lormetazepam
- losartan
- low calcium formula
- magnesium glycerophosphate
- magnesium sulphate
- mecasermin
- medronate
- medroxyprogesterone acetate
- meglitinides
- menotropin
- metformin
- methadone
- methimazole
- methylprednisolone
- metoprolol
- metyrapone
- miglitol
- mitotane
- mitoxantrone
- mozavaptan
- mtor inhibitors
- multivitamins
- naproxen
- natalizumab
- nateglinide
- nelivaptan
- neridronate
- nifedipine
- nilutamide
- nitrazepam
- nivolumab
- nsaid
- octreotide
- oestradiol valerate
- olanzapine
- olpadronate
- omeprazole
- opioids
- oral contraceptives
- orlistat
- ornipressin
- otelixizumab
- oxandrolone
- oxidronate
- oxybutynin
- paclitaxel
- pamidronate
- pancreatic enzymes
- pantoprazole
- paracetamol
- paroxetine
- pasireotide
- pegvisomant
- perindopril
- phenobarbital
- phenoxybenzamine
- phosphate binders
- phosphate supplements
- phytohaemagglutinin induced interferon gamma
- pioglitazone
- plicamycin
- potassium chloride
- potassium iodide
- pramlintide
- prazosin
- prednisolone
- prednisone
- premarin
- promethazine
- propranolol
- propylthiouracil
- protease inhibitors
- proton pump inhibitors
- pyridostigmine
- quetiapine
- quinagolide
- quinestrol
- radioactive mibg
- radioactive octreotide
- radioiodine
- raloxifene
- ramipril
- relcovaptan
- remogliflozin etabonate
- repaglinide
- risperidone
- risedronate
- rituximab
- romidepsin
- rosiglitazone
- salbutamol
- saline
- salmeterol
- salt supplements
- satavaptan
- saxagliptin
- selective progesterone receptor modulators
- selenium
- sglt2 inhibitors
- sildenafil
- simvastatin
- sirolimus
- sitagliptin
- sodium bicarbonate
- sodium chloride
- sodium polystyrene sulfonate (kayexalate)
- somatostatin analogues
- sorafenib
- spironolactone
- ssris
- statins
- streptozotocin
- steroids
- strontium ranelate
- sucralfate
- sulphonylureas
- sunitinib
- tamoxifen
- taspoglutide
- temazepam
- temozolomide
- teplizumab
- terazosin
- teriparatide
- testolactone
- testosterone enanthate esters
- tetrabenazine
- thalidomide
- thiazolidinediones
- thyrotropin alpha
- tibolone
- tiludronate
- tiratricol (triac)
- tofogliflozin
- tolazamide
- tolbutamide
- tolvaptan
- tramadol
- trastuzumab
- trazodone
- triamcinolone
- triamterene
- trimipramine
- troglitazone
- tryptophan
- turosteride
- tyrosine-kinase inhibitors
- valproic acid
- valrubicin
- vandetanib
- vaptans
- vildagliptin
- vinorelbine
- voglibose
- vorinostat
- warfarin
- zaleplon
- z-drugs
- zoledronic acid
- zolpidem
- zopiclone
- cardiology
- dermatology
- gastroenterology
- general practice
- genetics
- geriatrics
- gynaecology
- nephrology
- neurology
- nursing
- obstetrics
- oncology
- otolaryngology
- paediatrics
- pathology
- podiatry
- psychology/psychiatry
- radiology/rheumatology
- rehabilitation
- surgery
- urology
- insight into disease pathogenesis or mechanism of therapy
- novel diagnostic procedure
- novel treatment
- unique/unexpected symptoms or presentations of a disease
- new disease or syndrome: presentations/diagnosis/management
- unusual effects of medical treatment
- error in diagnosis/pitfalls and caveats
- february
- 2022
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Affiliation(s)
- Aria Jazdarehee
- Department of Medicine and Faculty of Medicine, University of British Columbia, British Columbia, Canada
| | - Sawyer Huget-Penner
- Division of Endocrinology and Metabolism, Fraser Health Authority, British Columbia, Canada
| | - Monika Pawlowska
- Division of Endocrinology and Metabolism, University of British Columbia, British Columbia, Canada
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24
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Leodori G, De Bartolo MI, Guerra A, Fabbrini A, Rocchi L, Latorre A, Paparella G, Belvisi D, Conte A, Bhatia KP, Rothwell JC, Berardelli A. Motor Cortical Network Excitability in Parkinson's Disease. Mov Disord 2022; 37:734-744. [PMID: 35001420 DOI: 10.1002/mds.28914] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Revised: 12/13/2021] [Accepted: 12/15/2021] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND Motor impairment in Parkinson's disease (PD) reflects changes in the basal ganglia-thalamocortical circuit converging on the primary motor cortex (M1) and supplementary motor area (SMA). Previous studies assessed M1 excitability in PD using transcranial magnetic stimulation (TMS)-evoked electromyographic activity. TMS-evoked electroencephalographic activity may unveil broader motor cortical network changes in PD. OBJECTIVE The aim was to assess motor cortical network excitability in PD. METHODS We compared TMS-evoked cortical potentials (TEPs) from M1 and the pre-SMA between 20 PD patients tested off and on medication and 19 healthy controls (HCs) and investigated possible correlations with bradykinesia. RESULTS Off PD patients compared to HCs had smaller P30 responses from the M1s contralateral (M1+) and ipsilateral (M1-) to the most bradykinetic side and increased pre-SMA N40. Dopaminergic therapy normalized the amplitude of M1+ and M1- P30 as well as pre-SMA N40. We found a positive correlation between M1+ P30 amplitude and bradykinesia in off PD patients. CONCLUSIONS Changes in M1 P30 and pre-SMA N40 in PD suggest that M1 excitability is reduced on both sides, whereas pre-SMA excitability is increased. The effect of dopaminergic therapy and the clinical correlation suggest that these cortical changes may reflect abnormal basal ganglia-thalamocortical activity. TMS electroencephalography provides novel insight into motor cortical network changes related to the pathophysiology of PD. © 2022 International Parkinson and Movement Disorder Society.
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Affiliation(s)
- Giorgio Leodori
- IRCCS Neuromed, Pozzilli, Italy.,Department of Human Neurosciences, Sapienza University of Rome, Rome, Italy
| | | | | | - Andrea Fabbrini
- Department of Human Neurosciences, Sapienza University of Rome, Rome, Italy
| | - Lorenzo Rocchi
- Department of Clinical and Movement Neurosciences, UCL Queen Square Institute of Neurology, University College London, London, United Kingdom.,Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy
| | - Anna Latorre
- Department of Clinical and Movement Neurosciences, UCL Queen Square Institute of Neurology, University College London, London, United Kingdom
| | | | - Daniele Belvisi
- IRCCS Neuromed, Pozzilli, Italy.,Department of Human Neurosciences, Sapienza University of Rome, Rome, Italy
| | - Antonella Conte
- IRCCS Neuromed, Pozzilli, Italy.,Department of Human Neurosciences, Sapienza University of Rome, Rome, Italy
| | - Kailash P Bhatia
- Department of Clinical and Movement Neurosciences, UCL Queen Square Institute of Neurology, University College London, London, United Kingdom
| | - John C Rothwell
- Department of Clinical and Movement Neurosciences, UCL Queen Square Institute of Neurology, University College London, London, United Kingdom
| | - Alfredo Berardelli
- IRCCS Neuromed, Pozzilli, Italy.,Department of Human Neurosciences, Sapienza University of Rome, Rome, Italy
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25
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Abstract
Parkinson's disease (PD) is known to affect the brain motor circuits involving the basal ganglia (BG) and to induce, among other signs, general slowness and paucity of movements. In upper limb movements, PD patients show a systematic prolongation of movement duration while maintaining a sufficient level of endpoint accuracy. PD appears to cause impairments not only in movement execution, but also in movement initiation and planning, as revealed by abnormal preparatory activity of motor-related brain areas. Grasping movement is affected as well, particularly in the coordination of the hand aperture with the transport phase. In the last fifty years, numerous behavioral studies attempted to clarify the mechanisms underlying these anomalies, speculating on the plausible role that the BG-thalamo-cortical circuitry may play in normal and pathological motor control. Still, many questions remain open, especially concerning the management of the speed-accuracy tradeoff and the online feedback control. In this review, we summarize the literature results on reaching and grasping in parkinsonian patients. We analyze the relevant hypotheses on the origins of dysfunction, by focusing on the motor control aspects involved in the different movement phases and the corresponding role played by the BG. We conclude with an insight into the innovative stimulation techniques and computational models recently proposed, which might be helpful in further clarifying the mechanisms through which PD affects reaching and grasping movements.
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Affiliation(s)
- Alessio Fasano
- The BioRobotics Institute, Scuola Superiore Sant’Anna, Pisa, Italy
- Department of Excellence in Robotics and AI, Scuola Superiore Sant’Anna, Pisa, Italy
- Correspondence to: Alessio Fasano and Egidio Falotico, The BioRobotics Institute, Scuola Superiore Sant’Anna, Polo Sant’Anna Valdera, Viale Rinaldo Piaggio, 34, 56025 Pontedera (PI), Italy. Tel.: +39 050 883 457; E-mails: and
| | - Alberto Mazzoni
- The BioRobotics Institute, Scuola Superiore Sant’Anna, Pisa, Italy
- Department of Excellence in Robotics and AI, Scuola Superiore Sant’Anna, Pisa, Italy
| | - Egidio Falotico
- The BioRobotics Institute, Scuola Superiore Sant’Anna, Pisa, Italy
- Department of Excellence in Robotics and AI, Scuola Superiore Sant’Anna, Pisa, Italy
- Correspondence to: Alessio Fasano and Egidio Falotico, The BioRobotics Institute, Scuola Superiore Sant’Anna, Polo Sant’Anna Valdera, Viale Rinaldo Piaggio, 34, 56025 Pontedera (PI), Italy. Tel.: +39 050 883 457; E-mails: and
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Wang SM, Ouyang WC, Hsu HM, Hsu LT. An Instrumental Measure of Hand and Facial Movement Abnormalities in Patients With Schizophrenia. Front Psychiatry 2022; 13:803661. [PMID: 35308887 PMCID: PMC8931260 DOI: 10.3389/fpsyt.2022.803661] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2021] [Accepted: 01/18/2022] [Indexed: 11/13/2022] Open
Abstract
INTRODUCTION Movement disorders have been suggested to be a cardinal component of schizophrenia. With increased research interests in this area, instrumental measures are needed. This study was to examine if the motion capture system was reliable in measuring hand and facial bradykinesia and dyskinesia and more sensitive to detecting movement differences between schizophrenia patients and healthy people than traditional rating scales. METHODS Sixteen schizophrenia patients and 20 control subjects were recruited. Hand and facial bradykinesia and dyskinesia were measured using the motion capture system and rated using the Extrapyramidal Symptom Rating Scale and the Abnormal Involuntary Movement Scale. RESULTS The system showed strong test-retest reliability and generated larger effect sizes of group differences than did the rating scales. CONCLUSIONS The results may support researchers and clinical practitioners to apply the system to sensitively measuring the hand and facial movement symptoms in schizophrenia patients, which contributes to gaining a deep understanding of movement issues in schizophrenia.
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Affiliation(s)
- Shu-Mei Wang
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Kowloon, Hong Kong SAR, China
| | - Wen-Chen Ouyang
- Department of Geriatric Psychiatry, Jianan Psychiatric Center, Ministry of Health and Welfare, Tainan, Taiwan.,Department of Nursing, Shu-Zen Junior College of Medicine and Management, Kaohsiung, Taiwan.,Department of Psychiatry, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Hsiao-Man Hsu
- Institute of Biomedical Engineering, College of Engineering, National Cheng Kung University, Tainan, Taiwan
| | - Li-Ta Hsu
- Department of Aeronautical and Aviation Engineering, The Hong Kong Polytechnic University, Kowloon, Hong Kong SAR, China
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27
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Samadzadeh S, Hefter H, Tezayak O, Rosenthal D. Mildly Impaired Foot Control in Long-Term Treated Patients with Wilson's Disease. J Funct Morphol Kinesiol 2021; 7:jfmk7010005. [PMID: 35076542 PMCID: PMC8788568 DOI: 10.3390/jfmk7010005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2021] [Revised: 12/24/2021] [Accepted: 12/27/2021] [Indexed: 01/23/2023] Open
Abstract
Abnormal gait is a common initial symptom of Wilson's disease, which responds well to therapy, but has not been analyzed in detail so far. In a pilot study, a mild gait disturbance could be detected in long-term treated Wilson patients. The question still is what the underlying functional deficit of this gait disturbance is and how this functional deficit correlates with further clinical and laboratory findings. In 30 long-term treated Wilson patients, the vertical component of foot ground reaction forces (GRF-curves) was analyzed during free walking without aid at the preferred gait speed over a distance of 40 m. An Infotronic® gait analysis system, consisting of soft tissue shoes with solid, but flexible plates containing eight force transducers, was used to record the pressure of the feet on the floor. Parameters of the GRF-curves were correlated with clinical scores as well as laboratory findings. The results of Wilson patients were compared to those of an age- and sex-matched control group. In 24 out of 30 Wilson patients and all controls, two peaks could be distinguished: the first "heel-on" and the second "push-off" peak. The heights of these peaks above the midstance valley were significantly reduced in the patients (p < 0.05). The time differences between peaks 1 or 2 and midstance valley were significantly negatively correlated with the total impairment score (p < 0.05). Gait speed was significantly correlated with the height of the "push-off" peak above the midstance valley (p < 0.045). The GRF-curves of free walking, long-term treated patients with Wilson's disease showed a reduced "push-off" peak as an underlying deficit to push the center of mass of the body to the contralateral side with the forefoot, explaining the reduction in gait speed during walking.
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Affiliation(s)
- Sara Samadzadeh
- Department of Neurology, University of Düsseldorf, Moorenstrasse 5, D-40225 Düsseldorf, Germany; (S.S.); (O.T.); (D.R.)
| | - Harald Hefter
- Department of Neurology, University of Düsseldorf, Moorenstrasse 5, D-40225 Düsseldorf, Germany; (S.S.); (O.T.); (D.R.)
- Correspondence:
| | - Osman Tezayak
- Department of Neurology, University of Düsseldorf, Moorenstrasse 5, D-40225 Düsseldorf, Germany; (S.S.); (O.T.); (D.R.)
- Department of Psychiatry, Psychiatriezentrum Kreuzlingen, Nationalstrasse 19, CH-8280 Kreuzlingen, Switzerland
| | - Dietmar Rosenthal
- Department of Neurology, University of Düsseldorf, Moorenstrasse 5, D-40225 Düsseldorf, Germany; (S.S.); (O.T.); (D.R.)
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28
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Habets JGV, Herff C, Kubben PL, Kuijf ML, Temel Y, Evers LJW, Bloem BR, Starr PA, Gilron R, Little S. Rapid Dynamic Naturalistic Monitoring of Bradykinesia in Parkinson's Disease Using a Wrist-Worn Accelerometer. Sensors (Basel) 2021; 21:s21237876. [PMID: 34883886 PMCID: PMC8659489 DOI: 10.3390/s21237876] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/29/2021] [Revised: 11/19/2021] [Accepted: 11/22/2021] [Indexed: 01/07/2023]
Abstract
Motor fluctuations in Parkinson’s disease are characterized by unpredictability in the timing and duration of dopaminergic therapeutic benefits on symptoms, including bradykinesia and rigidity. These fluctuations significantly impair the quality of life of many Parkinson’s patients. However, current clinical evaluation tools are not designed for the continuous, naturalistic (real-world) symptom monitoring needed to optimize clinical therapy to treat fluctuations. Although commercially available wearable motor monitoring, used over multiple days, can augment neurological decision making, the feasibility of rapid and dynamic detection of motor fluctuations is unclear. So far, applied wearable monitoring algorithms are trained on group data. In this study, we investigated the influence of individual model training on short timescale classification of naturalistic bradykinesia fluctuations in Parkinson’s patients using a single-wrist accelerometer. As part of the Parkinson@Home study protocol, 20 Parkinson patients were recorded with bilateral wrist accelerometers for a one hour OFF medication session and a one hour ON medication session during unconstrained activities in their own homes. Kinematic metrics were extracted from the accelerometer data from the bodyside with the largest unilateral bradykinesia fluctuations across medication states. The kinematic accelerometer features were compared over the 1 h duration of recording, and medication-state classification analyses were performed on 1 min segments of data. Then, we analyzed the influence of individual versus group model training, data window length, and total number of training patients included in group model training, on classification. Statistically significant areas under the curves (AUCs) for medication induced bradykinesia fluctuation classification were seen in 85% of the Parkinson patients at the single minute timescale using the group models. Individually trained models performed at the same level as the group trained models (mean AUC both 0.70, standard deviation respectively 0.18 and 0.10) despite the small individual training dataset. AUCs of the group models improved as the length of the feature windows was increased to 300 s, and with additional training patient datasets. We were able to show that medication-induced fluctuations in bradykinesia can be classified using wrist-worn accelerometry at the time scale of a single minute. Rapid, naturalistic Parkinson motor monitoring has the clinical potential to evaluate dynamic symptomatic and therapeutic fluctuations and help tailor treatments on a fast timescale.
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Affiliation(s)
- Jeroen G. V. Habets
- Department of Neurosurgery, School of Mental Health and Neuroscience, Maastricht University, 6229 ER Maastricht, The Netherlands; (C.H.); (P.L.K.); (Y.T.)
- Correspondence: ; Tel.: +31-433-876-052
| | - Christian Herff
- Department of Neurosurgery, School of Mental Health and Neuroscience, Maastricht University, 6229 ER Maastricht, The Netherlands; (C.H.); (P.L.K.); (Y.T.)
| | - Pieter L. Kubben
- Department of Neurosurgery, School of Mental Health and Neuroscience, Maastricht University, 6229 ER Maastricht, The Netherlands; (C.H.); (P.L.K.); (Y.T.)
| | - Mark L. Kuijf
- Department of Neurology, School of Mental Health and Neuroscience, Maastricht University, 6229 ER Maastricht, The Netherlands;
| | - Yasin Temel
- Department of Neurosurgery, School of Mental Health and Neuroscience, Maastricht University, 6229 ER Maastricht, The Netherlands; (C.H.); (P.L.K.); (Y.T.)
| | - Luc J. W. Evers
- Department of Neurology, Center of Expertise for Parkinson & Movement Disorders, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, 6525 GC Nijmegen, The Netherlands; (L.J.W.E.); (B.R.B.)
| | - Bastiaan R. Bloem
- Department of Neurology, Center of Expertise for Parkinson & Movement Disorders, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, 6525 GC Nijmegen, The Netherlands; (L.J.W.E.); (B.R.B.)
| | - Philip A. Starr
- Department of Movement Disorders and Neuromodulation, University of California San Francisco, San Francisco, CA 94143, USA; (P.A.S.); (R.G.); (S.L.)
| | - Ro’ee Gilron
- Department of Movement Disorders and Neuromodulation, University of California San Francisco, San Francisco, CA 94143, USA; (P.A.S.); (R.G.); (S.L.)
| | - Simon Little
- Department of Movement Disorders and Neuromodulation, University of California San Francisco, San Francisco, CA 94143, USA; (P.A.S.); (R.G.); (S.L.)
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29
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Garcia-Agundez A, Eickhoff C. Towards Objective Quantification of Hand Tremors and Bradykinesia Using Contactless Sensors: A Systematic Review. Front Aging Neurosci 2021; 13:716102. [PMID: 34759810 PMCID: PMC8572888 DOI: 10.3389/fnagi.2021.716102] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [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: 05/28/2021] [Accepted: 09/27/2021] [Indexed: 11/26/2022] Open
Abstract
Assessing the progression of movement disorders such as Parkinson's Disease (PD) is key in adjusting therapeutic interventions. However, current methods are still based on subjective factors such as visual observation, resulting in significant inter-rater variability on clinical scales such as UPDRS. Recent studies show the potential of sensor-based methods to address this limitation. The goal of this systematic review is to provide an up-to-date analysis of contactless sensor-based methods to estimate hand dexterity UPDRS scores in PD patients. Two hundred and twenty-four abstracts were screened and nine articles selected for analysis. Evidence obtained in a cumulative cohort of n = 187 patients and 1, 385 samples indicates that contactless sensors, particularly the Leap Motion Controller (LMC), can be used to assess UPDRS hand motor tasks 3.4, 3.5, 3.6, 3.15, and 3.17, although accuracy varies. Early evidence shows that sensor-based methods have clinical potential and might, after refinement, complement, or serve as a support to subjective assessment procedures. Given the nature of UPDRS assessment, future studies should observe whether LMC classification error falls within inter-rater variability for clinician-measured UPDRS scores to validate its clinical utility. Conversely, variables relevant to LMC classification such as power spectral densities or movement opening and closing speeds could set the basis for the design of more objective expert systems to assess hand dexterity in PD.
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Affiliation(s)
- Augusto Garcia-Agundez
- AI Lab, Brown Center for Biomedical Informatics, Brown University, Providence, RI, United States
| | - Carsten Eickhoff
- AI Lab, Brown Center for Biomedical Informatics, Brown University, Providence, RI, United States
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Shrestha N, Abe RAM, Masroor A, Khorochkov A, Prieto J, Singh KB, Nnadozie MC, Abdal M, Mohammed L. The Correlation Between Parkinson's Disease and Rapid Eye Movement Sleep Behavior Disorder: A Systematic Review. Cureus 2021; 13:e17026. [PMID: 34522507 PMCID: PMC8425494 DOI: 10.7759/cureus.17026] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2021] [Accepted: 08/09/2021] [Indexed: 11/21/2022] Open
Abstract
Parkinson's disease (PD) is a neurodegenerative disease caused due to the destruction of dopaminergic neurons and the deposition of α-synuclein proteins, known as Lewy bodies. Generally, the diagnosis of PD is centered around motor symptoms. However, the early recognition of non-motor symptoms such as autonomic dysfunction, sleep disturbances, and cognitive and psychiatric disturbances are gaining increased attention for the early diagnosis of PD. Rapid eye movement (REM) sleep behavior disorder or REM sleep behavior disorder (RBD) is described as parasomnia, which is a condition of loss of normal muscle atonia causing the person to act out vivid dreams and it has been seen to be associated with the misprocessing of intercellular α-synuclein leading to neurodegenerative diseases such as PD. This review's objective is to highlight the significance of RBD as a prodromal premotor marker for the early detection of PD. We used PubMed as our primary database to search for articles on May 2, 2021, and a total of 1849 articles were found in our initial search using keywords and medical subject heading (MeSH) keywords. Thereafter, we removed the duplicates, applied the inclusion/exclusion criteria, and did a quality appraisal to include 10 articles in this study. We concluded that the recognition and diagnosis of RBD are of paramount importance to detect early PD, and further longitudinal studies and clinical trials are of utmost importance to understand their correlation; also, treatment trials are needed to prevent the phenoconversion of RBD into PD.
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Affiliation(s)
- Niki Shrestha
- Internal Medicine, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
| | - Rose Anne M Abe
- Research, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
| | - Anum Masroor
- Psychiatry, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
- Psychiatry, Psychiatric Care Associates, Englewood, USA
- Medicine, Khyber Medical College, Peshawar, PAK
| | - Arseni Khorochkov
- Internal Medicine, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
| | - Jose Prieto
- Internal Medicine, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
| | - Karan B Singh
- Internal Medicine, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
| | - Maduka C Nnadozie
- Research, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
| | - Muhammad Abdal
- Emergency Medicine, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
| | - Lubna Mohammed
- Internal Medicine, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
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31
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Guerra A, Colella D, Giangrosso M, Cannavacciuolo A, Paparella G, Fabbrini G, Suppa A, Berardelli A, Bologna M. Driving motor cortex oscillations modulates bradykinesia in Parkinson's disease. Brain 2021; 145:224-236. [PMID: 34245244 DOI: 10.1093/brain/awab257] [Citation(s) in RCA: 42] [Impact Index Per Article: 14.0] [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: 03/26/2021] [Revised: 06/16/2021] [Accepted: 06/17/2021] [Indexed: 11/13/2022] Open
Abstract
In Parkinson's disease (PD) patients, beta (β) and gamma (γ) oscillations are altered in the basal ganglia, and this abnormality contributes to the pathophysiology of bradykinesia. However, it is unclear whether β and γ rhythms at the primary motor cortex (M1) level influence bradykinesia. Transcranial alternating current stimulation (tACS) can modulate cortical rhythms by entraining endogenous oscillations. We tested whether β- and γ-tACS on M1 modulate bradykinesia in PD patients by analyzing the kinematic features of repetitive finger tapping, including movement amplitude, velocity, and sequence effect, recorded during β-, γ-, and sham tACS. We also verified whether possible tACS-induced bradykinesia changes depended on modifications in specific M1 circuits, as assessed by short-interval intracortical inhibition (SICI) and short-latency afferent inhibition (SAI). Patients were studied OFF and ON dopaminergic therapy. Results were compared to those obtained in a group of healthy subjects (HS). In patients, movement velocity significantly worsened during β-tACS and movement amplitude improved during γ-tACS, while the sequence effect did not change. In addition, SAI decreased (reduced inhibition) during β-tACS and SICI decreased during both γ- and β-tACS in PD. The effects of tACS were comparable between OFF and ON sessions. In patients OFF therapy, the degree of SICI modulation during β- and γ-tACS correlated with movement velocity and amplitude changes. Moreover, there was a positive correlation between the effect of γ-tACS on movement amplitude and motor symptoms severity. Our results show that cortical β and γ oscillations are relevant in the pathophysiology of bradykinesia in PD and that changes in inhibitory GABA-A-ergic interneuronal activity may reflect compensatory M1 mechanisms to counteract bradykinesia. In conclusion, abnormal oscillations at the M1 level of the basal ganglia-thalamo-cortical network play a relevant role in the pathophysiology of bradykinesia in PD.
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Affiliation(s)
| | - Donato Colella
- Department of Human Neurosciences, Sapienza University of Rome, Italy
| | | | | | | | - Giovanni Fabbrini
- IRCCS Neuromed, Pozzilli (IS), Italy.,Department of Human Neurosciences, Sapienza University of Rome, Italy
| | - Antonio Suppa
- IRCCS Neuromed, Pozzilli (IS), Italy.,Department of Human Neurosciences, Sapienza University of Rome, Italy
| | - Alfredo Berardelli
- IRCCS Neuromed, Pozzilli (IS), Italy.,Department of Human Neurosciences, Sapienza University of Rome, Italy
| | - Matteo Bologna
- IRCCS Neuromed, Pozzilli (IS), Italy.,Department of Human Neurosciences, Sapienza University of Rome, Italy
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Simonet C, Galmes MA, Lambert C, Rees RN, Haque T, Bestwick JP, Lees AJ, Schrag A, Noyce AJ. Slow Motion Analysis of Repetitive Tapping (SMART) Test: Measuring Bradykinesia in Recently Diagnosed Parkinson's Disease and Idiopathic Anosmia. J Parkinsons Dis 2021; 11:1901-1915. [PMID: 34180422 DOI: 10.3233/jpd-212683] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Bradykinesia is the defining motor feature of Parkinson's disease (PD). There are limitations to its assessment using standard clinical rating scales, especially in the early stages of PD when a floor effect may be observed. OBJECTIVE To develop a quantitative method to track repetitive tapping movements and to compare people in the early stages of PD, healthy controls, and individuals with idiopathic anosmia. METHODS This was a cross-sectional study of 99 participants (early-stage PD = 26, controls = 64, idiopathic anosmia = 9). For each participant, repetitive finger tapping was recorded over 20 seconds using a smartphone at 240 frames per second. From each video, amplitude between fingers, frequency (number of taps per second), and velocity (distance travelled per second) was extracted. Clinical assessment was based on the motor section of the MDS-UPDRS. RESULTS People in the early stage of PD performed the task with slower velocity (p < 0.001) and with greater frequency slope than controls (p = 0.003). The combination of reduced velocity and greater frequency slope obtained the best accuracy to separate early-stage PD from controls based on metric thresholds alone (AUC = 0.88). Individuals with anosmia exhibited slower velocity (p = 0.001) and smaller amplitude (p < 0.001) compared with controls. CONCLUSION We present a simple, proof-of-concept method to detect early motor dysfunction in PD. Mean tap velocity appeared to be the best parameter to differentiate patients with PD from controls. Patients with anosmia also showed detectable differences in motor performance compared with controls which may suggest that some were in the prodromal phase of PD.
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Affiliation(s)
- Cristina Simonet
- Preventive Neurology Unit, Wolfson Institute of Preventive Medicine, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, United Kingdom
| | - Miquel A Galmes
- Physical and Analytical Chemistry Department, Jaume I University, Castelló de la Plana, Spain
| | | | - Richard N Rees
- Department of Clinical and Movement Neuroscience, UCL Institute of Neurology, London, United Kingdom
| | - Tahrina Haque
- Preventive Neurology Unit, Wolfson Institute of Preventive Medicine, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, United Kingdom
| | - Jonathan P Bestwick
- Preventive Neurology Unit, Wolfson Institute of Preventive Medicine, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, United Kingdom
| | - Andrew J Lees
- Reta Lila Weston Institute of Neurological Studies, University College London Queen Square Institute of Neurology, London, United Kingdom
| | - Anette Schrag
- Preventive Neurology Unit, Wolfson Institute of Preventive Medicine, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, United Kingdom.,Department of Clinical and Movement Neuroscience, UCL Institute of Neurology, London, United Kingdom
| | - Alastair J Noyce
- Preventive Neurology Unit, Wolfson Institute of Preventive Medicine, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, United Kingdom.,Department of Clinical and Movement Neuroscience, UCL Institute of Neurology, London, United Kingdom
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33
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Bliss RR, Church FC. Golf as a Physical Activity to Potentially Reduce the Risk of Falls in Older Adults with Parkinson's Disease. Sports (Basel) 2021; 9:sports9060072. [PMID: 34070988 PMCID: PMC8224548 DOI: 10.3390/sports9060072] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [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: 04/23/2021] [Revised: 05/17/2021] [Accepted: 05/20/2021] [Indexed: 12/11/2022] Open
Abstract
Advanced age is associated with an increased risk for falls in aging adults. Older adults are also more likely to be diagnosed with Parkinson’s disease (PD), with advanced age as the most significant risk factor. PD is a neurodegenerative disorder with four Cardinal motor symptoms: rigidity, bradykinesia, postural instability, and tremor. Thus, people (person)-with-Parkinson’s disease (PwP) have an even greater risk of falling than non-disorder age-matched peers. Exercise is an activity requiring physical effort, typically carried out to sustain or improve overall health and fitness, and it lowers the risk of falls in the general population. The sport of golf provides a low-impact all-around workout promoting a range of motion, activation of muscles in the upper and lower body, flexibility, and balance. Swinging a golf club offers a unique combination of high amplitude axial rotation, strengthening postural musculature, coordination, and stabilization, demonstrating the potential to impact PD symptoms positively. Golf may be a novel exercise treatment regimen for PD to use in conjunction with traditional medical therapy. We completed a literature review to determine the relationship between the game of golf, PD, and the risk of falls. We concluded that regularly playing golf can lower the risk for falls in community ambulating older adults with PD and demonstrates the potential to improve quality of life for PwP.
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Affiliation(s)
| | - Frank C. Church
- Department of Pathology and Laboratory Medicine, The University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, NC 27599, USA
- Correspondence:
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Paparella G, Fasano A, Hallett M, Berardelli A, Bologna M. Emerging concepts on bradykinesia in non-parkinsonian conditions. Eur J Neurol 2021; 28:2403-2422. [PMID: 33793037 DOI: 10.1111/ene.14851] [Citation(s) in RCA: 21] [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: 01/30/2021] [Revised: 03/24/2021] [Accepted: 03/29/2021] [Indexed: 12/22/2022]
Abstract
BACKGROUND AND PURPOSE Bradykinesia is one of the cardinal motor symptoms of Parkinson's disease. However, clinical and experimental studies indicate that bradykinesia may also be observed in various neurological diseases not primarily characterized by parkinsonism. These conditions include hyperkinetic movement disorders, such as dystonia, chorea, and essential tremor. Bradykinesia may also be observed in patients with neurological conditions that are not seen as "movement disorders," including those characterized by the involvement of the cerebellum and corticospinal system, dementia, multiple sclerosis, and psychiatric disorders. METHODS We reviewed clinical reports and experimental studies on bradykinesia in non-parkinsonian conditions and discussed the major findings. RESULTS Bradykinesia is a common motor abnormality in non-parkinsonian conditions. From a pathophysiological standpoint, bradykinesia in neurological conditions not primarily characterized by parkinsonism may be explained by brain network dysfunction. CONCLUSION In addition to the pathophysiological implications, the present paper highlights important terminological issues and the need for a new, more accurate, and more widely used definition of bradykinesia in the context of movement disorders and other neurological conditions.
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Affiliation(s)
| | - Alfonso Fasano
- Edmond J. Safra Program in Parkinson's Disease, Morton and Gloria Shulman Movement Disorders Clinic, Toronto Western Hospital, University Health Network, Toronto, Ontario, Canada.,Division of Neurology, University of Toronto, Toronto, Ontario, Canada.,Krembil Brain Institute, Toronto, Ontario, Canada
| | - Mark Hallett
- Human Motor Control Section, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, Maryland, USA
| | - Alfredo Berardelli
- IRCCS Neuromed, Pozzilli, Italy.,Department of Human Neurosciences, Sapienza University of Rome, Rome, Italy
| | - Matteo Bologna
- IRCCS Neuromed, Pozzilli, Italy.,Department of Human Neurosciences, Sapienza University of Rome, Rome, Italy
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35
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Yu RL, Tu SC, Wu RM, Lu PA, Tan CH. Interactions of COMT and ALDH2 Genetic Polymorphisms on Symptoms of Parkinson's Disease. Brain Sci 2021; 11:361. [PMID: 33808974 DOI: 10.3390/brainsci11030361] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2021] [Revised: 03/06/2021] [Accepted: 03/09/2021] [Indexed: 11/17/2022] Open
Abstract
(1) Background: Monoamine neurotransmitters play essential roles in the normal functioning of our nervous system. However, the metabolism of monoamine neurotransmitters is accompanied by the production of neurotoxic metabolites, and inefficient removal of the metabolites has been suggested to cause neurodegeneration. (2) Methods: To examine the effect of reduced activity of catechol-O-methyltransferase (COMT) and aldehyde dehydrogenase 2 (ALDH2) conferred by single nucleotide polymorphisms COMT rs4680(A) and ALDH2 rs671(A) on the symptoms of patients with Parkinson’s disease (PD), a total of 114 PD patients were recruited cross-sectionally and received genotyping for rs4680 and rs671 along with MDS-UPDRS evaluation. (3) Results: We found that patients carrying rs4680(A) had more severe bradykinesia in the upper extremity and rest tremor. Besides, patients carrying rs671(A) had more difficulty maintaining personal hygiene, while patients with genotype rs671(GG) had higher scores in the item “depressed mood.” More importantly, we found the effect of rs4680 to be moderated by rs671 SNP for the symptom of “hand movements.” The detrimental impact of rs4680(A) is more pronounced in the presence of genotype rs671(GG). (4) Conclusions: This study facilitates a deeper understanding of the detrimental effect of reduced activity of COMT and ALDH2 conferred by genetic variation and provides novel insight into the interactions between enzymes metabolizing monoamine neurotransmitters in the pathogenesis of PD.
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Kehnemouyi YM, Wilkins KB, Anidi CM, Anderson RW, Afzal MF, Bronte-Stewart HM. Modulation of beta bursts in subthalamic sensorimotor circuits predicts improvement in bradykinesia. Brain 2021; 144:473-486. [PMID: 33301569 PMCID: PMC8240742 DOI: 10.1093/brain/awaa394] [Citation(s) in RCA: 47] [Impact Index Per Article: 15.7] [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: 06/11/2020] [Accepted: 09/09/2020] [Indexed: 01/25/2023] Open
Abstract
No biomarker of Parkinson's disease exists that allows clinicians to adjust chronic therapy, either medication or deep brain stimulation, with real-time feedback. Consequently, clinicians rely on time-intensive, empirical, and subjective clinical assessments of motor behaviour and adverse events to adjust therapies. Accumulating evidence suggests that hypokinetic aspects of Parkinson's disease and their improvement with therapy are related to pathological neural activity in the beta band (beta oscillopathy) in the subthalamic nucleus. Additionally, effectiveness of deep brain stimulation may depend on modulation of the dorsolateral sensorimotor region of the subthalamic nucleus, which is the primary site of this beta oscillopathy. Despite the feasibility of utilizing this information to provide integrated, biomarker-driven precise deep brain stimulation, these measures have not been brought together in awake freely moving individuals. We sought to directly test whether stimulation-related improvements in bradykinesia were contingent on reduction of beta power and burst durations, and/or the volume of the sensorimotor subthalamic nucleus that was modulated. We recorded synchronized local field potentials and kinematic data in 16 subthalamic nuclei of individuals with Parkinson's disease chronically implanted with neurostimulators during a repetitive wrist-flexion extension task, while administering randomized different intensities of high frequency stimulation. Increased intensities of deep brain stimulation improved movement velocity and were associated with an intensity-dependent reduction in beta power and mean burst duration, measured during movement. The degree of reduction in this beta oscillopathy was associated with the improvement in movement velocity. Moreover, the reduction in beta power and beta burst durations was dependent on the theoretical degree of tissue modulated in the sensorimotor region of the subthalamic nucleus. Finally, the degree of attenuation of both beta power and beta burst durations, together with the degree of overlap of stimulation with the sensorimotor subthalamic nucleus significantly explained the stimulation-related improvement in movement velocity. The above results provide direct evidence that subthalamic nucleus deep brain stimulation-related improvements in bradykinesia are related to the reduction in beta oscillopathy within the sensorimotor region. With the advent of sensing neurostimulators, this beta oscillopathy combined with lead location could be used as a marker for real-time feedback to adjust clinical settings or to drive closed-loop deep brain stimulation in freely moving individuals with Parkinson's disease.
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Affiliation(s)
- Yasmine M Kehnemouyi
- Stanford University School of Medicine, Department of Neurology and Neurological Sciences, Stanford, CA, USA
| | - Kevin B Wilkins
- Stanford University School of Medicine, Department of Neurology and Neurological Sciences, Stanford, CA, USA
| | - Chioma M Anidi
- Stanford University School of Medicine, Department of Neurology and Neurological Sciences, Stanford, CA, USA
- The University of Michigan School of Medicine, Ann Arbor, MI, USA
| | - Ross W Anderson
- Stanford University School of Medicine, Department of Neurology and Neurological Sciences, Stanford, CA, USA
| | - Muhammad Furqan Afzal
- Stanford University School of Medicine, Department of Neurology and Neurological Sciences, Stanford, CA, USA
- Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Helen M Bronte-Stewart
- Stanford University School of Medicine, Department of Neurology and Neurological Sciences, Stanford, CA, USA
- Stanford University School of Medicine, Department of Neurosurgery, Stanford, CA, USA
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Channa A, Ifrim RC, Popescu D, Popescu N. A-WEAR Bracelet for Detection of Hand Tremor and Bradykinesia in Parkinson's Patients. Sensors (Basel) 2021; 21:981. [PMID: 33540570 PMCID: PMC7867124 DOI: 10.3390/s21030981] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Revised: 01/22/2021] [Accepted: 01/26/2021] [Indexed: 02/05/2023]
Abstract
Parkinson's disease patients face numerous motor symptoms that eventually make their life different from those of normal healthy controls. Out of these motor symptoms, tremor and bradykinesia, are relatively prevalent in all stages of this disease. The assessment of these symptoms is usually performed by traditional methods where the accuracy of results is still an open question. This research proposed a solution for an objective assessment of tremor and bradykinesia in subjects with PD (10 older adults aged greater than 60 years with tremor and 10 older adults aged greater than 60 years with bradykinesia) and 20 healthy older adults aged greater than 60 years. Physical movements were recorded by means of an AWEAR bracelet developed using inertial sensors, i.e., 3D accelerometer and gyroscope. Participants performed upper extremities motor activities as adopted by neurologists during the clinical assessment based on Unified Parkinson's Disease Rating Scale (UPDRS). For discriminating the patients from healthy controls, temporal and spectral features were extracted, out of which non-linear temporal and spectral features show greater difference. Both supervised and unsupervised machine learning classifiers provide good results. Out of 40 individuals, neural net clustering discriminated 34 individuals in correct classes, while the KNN approach discriminated 91.7% accurately. In a clinical environment, the doctor can use the device to comprehend the tremor and bradykinesia of patients quickly and with higher accuracy.
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Affiliation(s)
- Asma Channa
- Computer Science Department, University POLITEHNICA of Bucharest, RO-060042 Bucharest, Romania; (A.C.); (R.-C.I.); (D.P.)
- DIIES Department, University Mediterranea of Reggio Calabria, 89100 Reggio Calabria, Italy
| | - Rares-Cristian Ifrim
- Computer Science Department, University POLITEHNICA of Bucharest, RO-060042 Bucharest, Romania; (A.C.); (R.-C.I.); (D.P.)
| | - Decebal Popescu
- Computer Science Department, University POLITEHNICA of Bucharest, RO-060042 Bucharest, Romania; (A.C.); (R.-C.I.); (D.P.)
| | - Nirvana Popescu
- Computer Science Department, University POLITEHNICA of Bucharest, RO-060042 Bucharest, Romania; (A.C.); (R.-C.I.); (D.P.)
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Taylor PN, Sampson T, Beare B, Donavon-Hall M, Thomas PW, Marques E, Strike P, Seary C, Stevenson VL, Padiachy D, Lee J, Nell S. The effectiveness of peroneal nerve functional electrical simulation for the reduction of bradykinesia in Parkinson's disease: A feasibility study for a randomised control trial. Clin Rehabil 2020; 35:546-557. [PMID: 33826449 DOI: 10.1177/0269215520972519] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVES To assess the feasibility of a multi-site randomised controlled trial to evaluate the effect of functional electrical stimulation on bradykinesia in people with Parkinson's disease. DESIGN A two-arm assessor blinded randomised controlled trial with an 18 weeks intervention period and 4 weeks post-intervention follow-up. SETTING Two UK hospitals; a therapy outpatient department in a district general hospital and a specialist neuroscience centre. PARTICIPANTS A total of 64 participants with idiopathic Parkinson's disease and slow gait <1.25 ms-1. INTERVENTIONS Functional electrical stimulation delivered to the common peroneal nerve while walking in addition to standard care compared with standard care alone. MAIN MEASURES Feasibility aims included the determination of sample size, recruitment and retention rates, acceptability of the protocol and confirmation of the primary outcome measure. The outcome measures were 10 m walking speed, Unified Parkinson's Disease Rating Scale (UPDRS), Mini Balance Evaluation Systems Test, Parkinson's Disease Questionnaire-39, EuroQol 5-dimension 5-level, New Freezing of Gait questionnaire, Falls Efficacy Score International and falls diary. Participants opinion on the study design and relevance of outcome measures were evaluated using an embedded qualitative study. RESULTS There was a mean difference between groups of 0.14 ms-1 (CI 0.03, 0.26) at week 18 in favour of the treatment group, which was maintained at week 22, 0.10 ms-1 (CI -0.05, 0.25). There was a mean difference in UPDRS motor examination score of -3.65 (CI -4.35, 0.54) at week 18 which was lost at week 22 -0.91 (CI -2.19, 2.26). CONCLUSION The study design and intervention were feasible and supportive for a definitive trial. While both the study protocol and intervention were acceptable, recommendations for modifications are made.
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Affiliation(s)
- Paul N Taylor
- Salisbury NHS Foundation Trust, Salisbury, Wiltshire, UK.,Odstock Medical Limited, Salisbury District Hospital, Salisbury, Wiltshire, UK.,School of Health and Social Science, University of Bournemouth, Bournemouth, Dorset, UK
| | - Trish Sampson
- Salisbury NHS Foundation Trust, Salisbury, Wiltshire, UK
| | - Ben Beare
- National Hospital for Neurology and Neurosurgery, UCLH, London, UK
| | - Maggie Donavon-Hall
- School of Health Sciences, University of Southampton, Southampton, Hampshire, UK
| | - Peter W Thomas
- School of Health and Social Science, University of Bournemouth, Bournemouth, Dorset, UK
| | - Elsa Marques
- Musculoskeletal Research Unit, University of Bristol, Bristol, UK
| | - Paul Strike
- Salisbury NHS Foundation Trust, Salisbury, Wiltshire, UK
| | - Coralie Seary
- National Hospital for Neurology and Neurosurgery, UCLH, London, UK
| | | | - Diran Padiachy
- Salisbury NHS Foundation Trust, Salisbury, Wiltshire, UK
| | - James Lee
- Salisbury NHS Foundation Trust, Salisbury, Wiltshire, UK
| | - Sheila Nell
- Parkinson's UK, Salisbury Branch, Salisbury, Wiltshire, UK
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Chen L, Cai G, Weng H, Yu J, Yang Y, Huang X, Chen X, Ye Q. More Sensitive Identification for Bradykinesia Compared to Tremors in Parkinson's Disease Based on Parkinson's KinetiGraph (PKG). Front Aging Neurosci 2020; 12:594701. [PMID: 33240078 PMCID: PMC7670912 DOI: 10.3389/fnagi.2020.594701] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [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: 08/14/2020] [Accepted: 09/29/2020] [Indexed: 11/18/2022] Open
Abstract
The effective management and therapies for Parkinson's disease (PD) require appropriate clinical evaluation. The Parkinson's KinetiGraph (PKG) is a wearable sensor system that can monitor the motion characteristics of PD objectively and continuously. This study was aimed to assess the correlations between PKG data and clinical scores of bradykinesia, rigidity, tremor, and fluctuation. It also aims to explore the application value of identifying early motor symptoms. An observational study of 100 PD patients wearing the PKG for ≥ 6 days was performed. It provides a series of data, such as the bradykinesia score (BKS), percent time tremor (PTT), dyskinesia score (DKS), and fluctuation and dyskinesia score (FDS). PKG data and UPDRS scores were analyzed, including UPDRS III total scores, UPDRS III-bradykinesia scores (UPDRS III-B: items 23-26, 31), UPDRS III-rigidity scores (UPDRS III-R: item 22), and scores from the Wearing-off Questionnaire (WOQ-9). This study shows that there was significant correlation between BKS and UPDRS III scores, including UPDRS III total scores, UPDRS III-B, and UPDRS III-R scores (r = 0.479-0.588, p ≤ 0.001), especially in the early-stage group (r = 0.682, p < 0.001). Furthermore, we found that BKS in patients with left-sided onset (33.57 ± 5.14, n = 37) is more serious than in patients with right-sided onset (29.87 ± 6.86, n = 26). Our findings support the feasibility of using the PKG to detect abnormal movements, especially bradykinesia in PD. It is suitable for the early detection, remote monitoring, and timely treatment of PD symptoms.
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Affiliation(s)
- Lina Chen
- Department of Neurology, Fujian Institute of Geriatrics, Fujian Medical University Union Hospital, Fuzhou, China
| | - Guoen Cai
- Department of Neurology, Fujian Institute of Geriatrics, Fujian Medical University Union Hospital, Fuzhou, China
| | - Huidan Weng
- Department of Neurology, Fujian Institute of Geriatrics, Fujian Medical University Union Hospital, Fuzhou, China
| | - Jiao Yu
- Department of Neurology, Fujian Institute of Geriatrics, Fujian Medical University Union Hospital, Fuzhou, China
| | - Yu Yang
- Department of Neurology, Fujian Institute of Geriatrics, Fujian Medical University Union Hospital, Fuzhou, China
| | - Xuanyu Huang
- Department of Neurology, Fujian Institute of Geriatrics, Fujian Medical University Union Hospital, Fuzhou, China
| | - Xiaochun Chen
- Department of Neurology, Fujian Institute of Geriatrics, Fujian Medical University Union Hospital, Fuzhou, China
- Institute of Neuroscience, Fujian Key Laboratory of Molecular Neurology, Fujian Medical University, Fuzhou, China
| | - Qinyong Ye
- Department of Neurology, Fujian Institute of Geriatrics, Fujian Medical University Union Hospital, Fuzhou, China
- Institute of Neuroscience, Fujian Key Laboratory of Molecular Neurology, Fujian Medical University, Fuzhou, China
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40
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Harrison EC, Earhart GM, Leventhal D, Quinn L, Pietro Mazzoni. A walking dance to improve gait speed for people with Parkinson disease: a pilot study. Neurodegener Dis Manag 2020; 10:301-308. [PMID: 32878538 DOI: 10.2217/nmt-2020-0028] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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: 12/30/2022] Open
Abstract
Aim: To determine the effectiveness of a targeted dance intervention to improve walking speed for people with Parkinson disease (PD) by increasing motor motivation. Materials & methods: 11 participants with PD participated in a 6-week pilot study in which they learned a contemporary dance composed of walking steps and designed to mimic everyday walking. 1 h classes occurred twice-weekly. Results: Pre- and post-intervention assessments revealed a significant increase in gait speed (t9 = 3.30; p = 0.009), cadence (t9 = 2.345; p = 0.044), and stride length (t9 = 3.757; p = 0.005), and a significant decrease (improvement) in single support time variability (t9 = -2.744; p = 0.022). There were no significant changes in other measures of gait variability nor in motor symptoms, mood and anxiety, extent of life-space mobility, or quality of life. No adverse events were reported. Conclusion: Joywalk provides preliminary evidence that a targeted physical intervention for people with PD may specifically counter bradykinesia.
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Affiliation(s)
- Elinor C Harrison
- Department of Neurology, Washington University School of Medicine, St Louis, MO 63110, USA
| | - Gammon M Earhart
- Department of Neurology, Washington University School of Medicine, St Louis, MO 63110, USA.,Program in Physical Therapy, Washington University School of Medicine, St Louis, MO 63110, USA.,Department of Neuroscience, Washington University School of Medicine, St Louis, MO 63110, USA
| | - David Leventhal
- Dance For PD®, Mark Morris Dance Group, Brooklyn, NY 11217, USA
| | - Lori Quinn
- Department of Movement Science & Kinesiology, Teachers College, Columbia University, New York City, NY 10027, USA
| | - Pietro Mazzoni
- Department of Neurology, Washington University School of Medicine, St Louis, MO 63110, USA
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41
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McIver EL, Atherton JF, Chu HY, Cosgrove KE, Kondapalli J, Wokosin D, Surmeier DJ, Bevan MD. Maladaptive Downregulation of Autonomous Subthalamic Nucleus Activity following the Loss of Midbrain Dopamine Neurons. Cell Rep 2020; 28:992-1002.e4. [PMID: 31340159 PMCID: PMC6699776 DOI: 10.1016/j.celrep.2019.06.076] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [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: 08/29/2018] [Revised: 05/22/2019] [Accepted: 06/19/2019] [Indexed: 01/13/2023] Open
Abstract
Abnormal subthalamic nucleus (STN) activity is linked to impaired movement in Parkinson’s disease (PD). The autonomous firing of STN neurons, which contributes to their tonic excitation of the extrastriatal basal ganglia and shapes their integration of synaptic input, is downregulated in PD models. Using electrophysiological, chemogenetic, genetic, and optical approaches, we find that chemogenetic activation of indirect pathway striatopallidal neurons downregulates intrinsic STN activity in normal mice but this effect is occluded in Parkinsonian mice. Loss of autonomous spiking in PD mice is prevented by STN N-methyl-D-aspartate receptor (NMDAR) knockdown and reversed by reactive oxygen species breakdown or KATP channel inhibition. Chemogenetic activation of hM3D(Gq) in STN neurons in Parkinsonian mice rescues their intrinsic activity, modifies their synaptic integration, and ameliorates motor dysfunction. Together these data argue that in PD mice increased indirect pathway activity leads to disinhibition of the STN, which triggers maladaptive NMDAR-dependent downregulation of autonomous firing. McIver et al. describe the cellular and circuit mechanisms responsible for the loss of autonomous subthalamic nucleus (STN) spiking in dopamine-depleted mice and demonstrate that chemogenetic rescue of intrinsic STN activity reduces Parkinsonian motor dysfunction.
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Affiliation(s)
- Eileen L McIver
- Department of Physiology, Feinberg School of Medicine, Northwestern University, 303 E. Chicago Ave., Chicago, IL 60611, USA
| | - Jeremy F Atherton
- Department of Physiology, Feinberg School of Medicine, Northwestern University, 303 E. Chicago Ave., Chicago, IL 60611, USA
| | - Hong-Yuan Chu
- Department of Physiology, Feinberg School of Medicine, Northwestern University, 303 E. Chicago Ave., Chicago, IL 60611, USA
| | - Kathleen E Cosgrove
- Department of Physiology, Feinberg School of Medicine, Northwestern University, 303 E. Chicago Ave., Chicago, IL 60611, USA
| | - Jyothisri Kondapalli
- Department of Physiology, Feinberg School of Medicine, Northwestern University, 303 E. Chicago Ave., Chicago, IL 60611, USA
| | - David Wokosin
- Department of Physiology, Feinberg School of Medicine, Northwestern University, 303 E. Chicago Ave., Chicago, IL 60611, USA
| | - D James Surmeier
- Department of Physiology, Feinberg School of Medicine, Northwestern University, 303 E. Chicago Ave., Chicago, IL 60611, USA
| | - Mark D Bevan
- Department of Physiology, Feinberg School of Medicine, Northwestern University, 303 E. Chicago Ave., Chicago, IL 60611, USA.
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42
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Petersson P, Halje P, Cenci MA. Significance and Translational Value of High-Frequency Cortico-Basal Ganglia Oscillations in Parkinson's Disease. J Parkinsons Dis 2020; 9:183-196. [PMID: 30594935 PMCID: PMC6484276 DOI: 10.3233/jpd-181480] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
The mechanisms and significance of basal ganglia oscillations is a fundamental research question engaging both clinical and basic investigators. In Parkinson’s disease (PD), neural activity in basal ganglia nuclei is characterized by oscillatory patterns that are believed to disrupt the dynamic processing of movement-related information and thus generate motor symptoms. Beta-band oscillations associated with hypokinetic states have been reviewed in several excellent previous articles. Here we focus on faster oscillatory phenomena that have been reported in association with a diverse range of motor states. We review the occurrence of different types of fast oscillations and the evidence supporting their pathophysiological role. We also provide a general discussion on the definition, possible mechanisms, and translational value of synchronized oscillations of different frequencies in cortico-basal ganglia structures. Revealing how oscillatory phenomena are caused and spread in cortico-basal ganglia-thalamocortical networks will offer a key to unlock the neural codes of both motor and non-motor symptoms in PD. In preclinical therapeutic research, recording of oscillatory neural activities holds the promise to unravel mechanisms of action of current and future treatments.
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Affiliation(s)
- Per Petersson
- Department of Integrative Medical Biology, Umeå University, Umeå, Sweden.,Department of Experimental Medical Science, The Group for Integrative Neurophysiology and Neurotechnology, Lund University, Lund, Sweden
| | - Pär Halje
- Department of Integrative Medical Biology, Umeå University, Umeå, Sweden.,Department of Experimental Medical Science, The Group for Integrative Neurophysiology and Neurotechnology, Lund University, Lund, Sweden
| | - M Angela Cenci
- Department of Experimental Medical Science, Basal Ganglia Pathophysiology Unit, Lund University, Lund, Sweden
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43
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Vinding MC, Tsitsi P, Waldthaler J, Oostenveld R, Ingvar M, Svenningsson P, Lundqvist D. Reduction of spontaneous cortical beta bursts in Parkinson's disease is linked to symptom severity. Brain Commun 2020; 2:fcaa052. [PMID: 32954303 PMCID: PMC7425382 DOI: 10.1093/braincomms/fcaa052] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [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: 09/27/2019] [Revised: 02/13/2020] [Accepted: 03/24/2020] [Indexed: 11/18/2022] Open
Abstract
Parkinson's disease is characterized by a gradual loss of dopaminergic neurons, which is associated with altered neuronal activity in the beta-band (13-30 Hz). Assessing beta-band activity typically involves transforming the time-series to get the power of the signal in the frequency domain. Such transformation assumes that the time-series can be reduced to a combination of steady-state sine- and cosine waves. However, recent studies have suggested that this approach masks relevant biophysical features in the beta-band-for example, that the beta-band exhibits transient bursts of high-amplitude activity. In an exploratory study, we used magnetoencephalography to record beta-band activity from the sensorimotor cortex, to characterize how spontaneous cortical beta bursts manifest in Parkinson's patients on and off dopaminergic medication, and compare this to matched healthy controls. We extracted the time-course of beta-band activity from the sensorimotor cortex and characterized bursts in the signal. We then compared the burst rate, duration, inter-burst interval and peak amplitude between the Parkinson's patients and healthy controls. Our results show that Parkinson's patients off medication had a 5-17% lower beta bursts rate compared to healthy controls, while both the duration and the amplitude of the bursts were the same for healthy controls and medicated state of the Parkinson's patients. These data thus support the view that beta bursts are fundamental underlying features of beta-band activity, and show that changes in cortical beta-band power in Parkinson's disease can be explained-primarily by changes in the underlying burst rate. Importantly, our results also revealed a relationship between beta burst rate and motor symptom severity in Parkinson's disease: a lower burst rate scaled with increased severity of bradykinesia and postural/kinetic tremor. Beta burst rate might thus serve as a neuromarker for Parkinson's disease that can help in the assessment of symptom severity in Parkinson's disease or in the evaluation of treatment effectiveness.
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Affiliation(s)
- Mikkel C Vinding
- Department of Clinical Neuroscience, NatMEG, Karolinska Institutet, 171 77 Stockholm, Sweden
| | - Panagiota Tsitsi
- Department of Clinical Neuroscience, Neuro Svenningsson, Karolinska Institutet, Stockholm, Sweden
| | - Josefine Waldthaler
- Department of Clinical Neuroscience, Neuro Svenningsson, Karolinska Institutet, Stockholm, Sweden
- Department of Neurology, University Hospital Marburg, Marburg, Germany
| | - Robert Oostenveld
- Department of Clinical Neuroscience, NatMEG, Karolinska Institutet, 171 77 Stockholm, Sweden
- Donders Institute for Brain, Cognition and Behaviour, Radboud University, Nijmegen, Netherlands
| | - Martin Ingvar
- Department of Clinical Neuroscience, NatMEG, Karolinska Institutet, 171 77 Stockholm, Sweden
- Section of Neuroradiology, Karolinska University Hospital, Stockholm, Sweden
| | - Per Svenningsson
- Department of Clinical Neuroscience, Neuro Svenningsson, Karolinska Institutet, Stockholm, Sweden
| | - Daniel Lundqvist
- Department of Clinical Neuroscience, NatMEG, Karolinska Institutet, 171 77 Stockholm, Sweden
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Bologna M, Paparella G, Fasano A, Hallett M, Berardelli A. Evolving concepts on bradykinesia. Brain 2020; 143:727-750. [PMID: 31834375 PMCID: PMC8205506 DOI: 10.1093/brain/awz344] [Citation(s) in RCA: 103] [Impact Index Per Article: 25.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2019] [Revised: 09/02/2019] [Accepted: 09/06/2019] [Indexed: 12/20/2022] Open
Abstract
Bradykinesia is one of the cardinal motor symptoms of Parkinson's disease and other parkinsonisms. The various clinical aspects related to bradykinesia and the pathophysiological mechanisms underlying bradykinesia are, however, still unclear. In this article, we review clinical and experimental studies on bradykinesia performed in patients with Parkinson's disease and atypical parkinsonism. We also review studies on animal experiments dealing with pathophysiological aspects of the parkinsonian state. In Parkinson's disease, bradykinesia is characterized by slowness, the reduced amplitude of movement, and sequence effect. These features are also present in atypical parkinsonisms, but the sequence effect is not common. Levodopa therapy improves bradykinesia, but treatment variably affects the bradykinesia features and does not significantly modify the sequence effect. Findings from animal and patients demonstrate the role of the basal ganglia and other interconnected structures, such as the primary motor cortex and cerebellum, as well as the contribution of abnormal sensorimotor processing. Bradykinesia should be interpreted as arising from network dysfunction. A better understanding of bradykinesia pathophysiology will serve as the new starting point for clinical and experimental purposes.
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Affiliation(s)
- Matteo Bologna
- Department of Human Neurosciences, Sapienza University of Rome, Italy
- IRCCS Neuromed, Pozzilli (IS), Italy
| | | | - Alfonso Fasano
- Edmond J. Safra Program in Parkinson's Disease, Morton and Gloria Shulman Movement Disorders Clinic, Toronto Western Hospital, UHN, Toronto, Ontario, Canada
- Division of Neurology, University of Toronto, Toronto, Ontario, Canada
- Krembil Brain Institute, Toronto, Ontario, Canada
- Center for Advancing Neurotechnological Innovation to Application (CRANIA), Toronto, ON, Canada
| | - Mark Hallett
- Human Motor Control Section, National Institute of Neurological Disorders and Stroke, NIH, Bethesda, MD, USA
| | - Alfredo Berardelli
- Department of Human Neurosciences, Sapienza University of Rome, Italy
- IRCCS Neuromed, Pozzilli (IS), Italy
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Rahman MM, Chakraborti RR, Potol MA, Abir AH, Sharmin O, Alam M, Khan MFR, Afrin R, Jannat H, Wadud R, Habib ZF. Epalrestat improves motor symptoms by reducing oxidative stress and inflammation in the reserpine induced mouse model of Parkinson's disease. Animal Model Exp Med 2020; 3:9-21. [PMID: 32318655 PMCID: PMC7167235 DOI: 10.1002/ame2.12097] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2019] [Revised: 11/12/2019] [Accepted: 12/06/2019] [Indexed: 01/13/2023] Open
Abstract
BACKGROUND Parkinson's disease (PD) is a progressive neurodegenerative disorder affecting a large number of elderly people worldwide. The current therapies for PD are symptom-based; they do not provide a cure but improve the quality of life. Muscular dysfunction is the hallmark clinical feature of PD and oxidative stress and inflammation play a critical role in its pathogenesis. Epalrestat is used for the treatment of diabetic neuropathy and is known to improve antioxidative defense mechanisms in the CNS. Therefore, in this study, we investigated the role of Epalrestat in the reserpine induced mouse model of PD. METHOD We used Swiss Albino mice for the PD model and tested for akinesia/bradykinesia, muscular rigidity, palpebral ptosis, and tremor, as well as conducting swim and open field tests. Brain samples were used to determine oxidative stress parameters and infiltration of immune cells. RESULTS Epalrestat treatment significantly improved akinesia and bradykinesia, muscular dysfunctions, tremor level, and gait functions compared to the reserpine group. It also improved the latency in the swim test. Eplarestat significantly reduced lipid peroxidation and NO concentration in different brain tissues and increased the activity of antioxidative enzymes, glutathione, catalase, and superoxide dismutase. Furthermore, Epalrestat reduced neuroinflammation by reducing the number of infiltrating immune cells. CONCLUSION Eplarestat improves muscular dysfunction in PD by reducing oxidative stress and inflammation.
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Affiliation(s)
- Md. Mahbubur Rahman
- Laboratory of PharmacologyDepartment of Pharmaceutical SciencesSchool of Health & Life SciencesNorth South UniversityDhakaBangladesh
| | - Rupali Rani Chakraborti
- Laboratory of PharmacologyDepartment of Pharmaceutical SciencesSchool of Health & Life SciencesNorth South UniversityDhakaBangladesh
| | - Md. Abdullah Potol
- Laboratory of PharmacologyDepartment of Pharmaceutical SciencesSchool of Health & Life SciencesNorth South UniversityDhakaBangladesh
| | - Ariful Haque Abir
- Laboratory of PharmacologyDepartment of Pharmaceutical SciencesSchool of Health & Life SciencesNorth South UniversityDhakaBangladesh
| | - Ozayra Sharmin
- Laboratory of PharmacologyDepartment of Pharmaceutical SciencesSchool of Health & Life SciencesNorth South UniversityDhakaBangladesh
| | - Mahabub Alam
- Laboratory of PharmacologyDepartment of Pharmaceutical SciencesSchool of Health & Life SciencesNorth South UniversityDhakaBangladesh
| | - Md. Fazlur Rahman Khan
- Laboratory of PharmacologyDepartment of Pharmaceutical SciencesSchool of Health & Life SciencesNorth South UniversityDhakaBangladesh
| | - Rownock Afrin
- Laboratory of PharmacologyDepartment of Pharmaceutical SciencesSchool of Health & Life SciencesNorth South UniversityDhakaBangladesh
| | - Humayra Jannat
- Laboratory of PharmacologyDepartment of Pharmaceutical SciencesSchool of Health & Life SciencesNorth South UniversityDhakaBangladesh
| | - Rasiqh Wadud
- Laboratory of PharmacologyDepartment of Pharmaceutical SciencesSchool of Health & Life SciencesNorth South UniversityDhakaBangladesh
| | - Zaki Farhad Habib
- Laboratory of PharmacologyDepartment of Pharmaceutical SciencesSchool of Health & Life SciencesNorth South UniversityDhakaBangladesh
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46
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Robertson EE, Hall DA, Pal G, Ouyang B, Liu Y, Joyce JM, Berry-Kravis E, O'Keefe JA. Tremorography in fragile X-associated tremor/ataxia syndrome, Parkinson's disease and essential tremor. Clin Park Relat Disord 2020; 3:100040. [PMID: 34316626 PMCID: PMC8298795 DOI: 10.1016/j.prdoa.2020.100040] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [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: 08/19/2019] [Revised: 11/07/2019] [Accepted: 11/22/2019] [Indexed: 11/25/2022] Open
Abstract
Background Fragile X-associated tremor/ataxia syndrome (FXTAS), a neurodegenerative disease affecting carriers of a 55-200 CGG repeat in the fragile X mental retardation 1 gene, may receive an initial diagnosis of Parkinson's disease (PD) or essential tremor (ET) due to overlapping motor symptoms. Therefore, tremor and bradykinesia were compared in these disorders using quantitative tremorography. Methods The inertial sensor based Kinesia ™ system was used to quantify upper extremity tremor and bradykinesia in participants with FXTAS (n = 25), PD (n = 23), ET (n = 18) and controls (n = 20) and regression analysis was performed to determine whether tremorography measures distinguished between the groups. The FXTAS Rating scale (FXTAS-RS) was administered to determine whether sub-score items on the clinician rated scale correlated with tremorography variables. Results FXTAS participants had reduced finger tap speed compared to those with ET, and ET had increased kinetic tremor compared to PD. Higher kinetic tremor distinguished FXTAS from PD (p = .02), and lower finger tap speed distinguished FXTAS from ET (p = .004). FXTAS-RS tremor and bradykinesia items correlated with tremorography measures (p = .005 to <0.0001). Conclusions This is the first quantitative study to compare tremor and bradykinesia in FXTAS, PD and ET. Kinetic tremor and bradykinesia measures using a quantitative inertial sensor system distinguished FXTAS from PD and ET, respectively. Such technologies may be useful for detecting precise tremor and bradykinesia abnormalities and distinguishing the tremor and bradykinesia profiles in each of these disorders.
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Affiliation(s)
- Erin E Robertson
- Department of Cell and Molecular Medicine, Rush University Medical Center, Chicago, IL, United States of America
| | - Deborah A Hall
- Department of Neurological Sciences, Rush University Medical Center, Chicago, IL, United States of America
| | - Gian Pal
- Department of Neurological Sciences, Rush University Medical Center, Chicago, IL, United States of America
| | - Bichun Ouyang
- Department of Neurological Sciences, Rush University Medical Center, Chicago, IL, United States of America
| | - Yuanqing Liu
- Department of Neurological Sciences, Rush University Medical Center, Chicago, IL, United States of America
| | - Jessica M Joyce
- Department of Cell and Molecular Medicine, Rush University Medical Center, Chicago, IL, United States of America
| | - Elizabeth Berry-Kravis
- Department of Neurological Sciences, Rush University Medical Center, Chicago, IL, United States of America.,Department of Pediatrics, Rush University Medical Center, Chicago, IL, United States of America.,Department of Biochemistry, Rush University Medical Center, Chicago, IL, United States of America
| | - Joan A O'Keefe
- Department of Cell and Molecular Medicine, Rush University Medical Center, Chicago, IL, United States of America.,Department of Neurological Sciences, Rush University Medical Center, Chicago, IL, United States of America.,Rush Medical College, Rush University Medical Center, Chicago, IL, United States of America
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47
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Di Lazzaro G, Ricci M, Al-Wardat M, Schirinzi T, Scalise S, Giannini F, Mercuri NB, Saggio G, Pisani A. Technology-Based Objective Measures Detect Subclinical Axial Signs in Untreated, de novo Parkinson's Disease. JPD 2020; 10:113-122. [PMID: 31594252 DOI: 10.3233/jpd-191758] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
BACKGROUND Technology-based objective measures (TOMs) recently gained relevance to support clinicians in the assessment of motor function in Parkinson's disease (PD), although limited data are available in the early phases. OBJECTIVE To assess motor performances of a population of newly diagnosed, drug free PD patients using wearable inertial sensors and to compare them to healthy controls (HC) and differentiate different PD subtypes [tremor dominant (TD), postural instability gait disability (PIGD), and mixed phenotype (MP)]. METHODS We enrolled 65 subjects, 36 newly diagnosed, drug-free PD patients and 29 HCs. PD patients were clinically defined as tremor dominant, postural instability-gait difficulties or mixed phenotype. All 65 subjects performed seven MDS-UPDRS III motor tasks wearing inertial sensors: rest tremor, postural tremor, rapid alternating hand movement, foot tapping, heel-to-toe tapping, Timed-Up-and-Go test (TUG) and pull test. The most relevant motor tasks were found combining ReliefF ranking and Kruskal- Wallis feature-selection methods. We used these features, linked to the relevant motor tasks, to highlight differences between PD from HC, by means of Support Vector Machine (SVM) classifier. Furthermore, we adopted SVM to support the relevance of each motor task on the classification accuracy, excluding one task at time. RESULTS Motion analysis distinguished PD from HC with an accuracy as high as 97%, based on SVM performed with measured features from tremor and bradykinesia items, pull test and TUG. Heel-to-toe test was the most relevant, followed by TUG and Pull Test. CONCLUSIONS In this pilot study, we demonstrate that the SVM algorithm successfully distinguishes de novo drug-free PD patients from HC. Surprisingly, pull test and TUG tests provided relevant features for obtaining high SVM classification accuracy, differing from the report of the experienced examiner. The use of TOMs may improve diagnostic accuracy for these patients.
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Affiliation(s)
- Giulia Di Lazzaro
- Department of Systems Medicine, University of Rome Tor Vergata, Rome, Italy
| | - Mariachiara Ricci
- Department of Electronic Engineering, University of Rome Tor Vergata, Rome, Italy
| | - Mohammad Al-Wardat
- Department of Systems Medicine, University of Rome Tor Vergata, Rome, Italy
| | - Tommaso Schirinzi
- Department of Systems Medicine, University of Rome Tor Vergata, Rome, Italy
| | - Simona Scalise
- Department of Systems Medicine, University of Rome Tor Vergata, Rome, Italy
| | - Franco Giannini
- Department of Electronic Engineering, University of Rome Tor Vergata, Rome, Italy
| | - Nicola B Mercuri
- Department of Systems Medicine, University of Rome Tor Vergata, Rome, Italy
- Santa Lucia Foundation, IRCCS, Rome, Italy
| | - Giovanni Saggio
- Department of Electronic Engineering, University of Rome Tor Vergata, Rome, Italy
| | - Antonio Pisani
- Department of Systems Medicine, University of Rome Tor Vergata, Rome, Italy
- Santa Lucia Foundation, IRCCS, Rome, Italy
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48
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Macerollo A, Palmer C, Foltynie T, Korlipara P, Limousin P, Edwards M, Kilner JM. High-frequency peripheral vibration decreases completion time on a number of motor tasks. Eur J Neurosci 2019; 48:1789-1802. [PMID: 29923362 PMCID: PMC6175240 DOI: 10.1111/ejn.14050] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [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: 05/30/2018] [Accepted: 06/18/2018] [Indexed: 02/01/2023]
Abstract
A recent theoretical account of motor control proposes that modulation of afferent information plays a role in affecting how readily we can move. Increasing the estimate of uncertainty surrounding the afferent input is a necessary step in being able to move. It has been proposed that an inability to modulate the gain of this sensory information underlies the cardinal symptoms of Parkinson's disease (PD). We aimed to test this theory by modulating the uncertainty of the proprioceptive signal using high‐frequency peripheral vibration, to determine the subsequent effect on motor performance. We investigated if this peripheral stimulus might modulate oscillatory activity over the sensorimotor cortex in order to understand the mechanism by which peripheral vibration can change motor performance. We found that 80 Hz peripheral vibration applied to the right wrist of a total of 54 healthy human participants reproducibly improved performance across four separate randomised experiments on a number of motor control tasks (nine‐hole peg task, box and block test, reaction time task and finger tapping). Improved performance on all motor tasks (except the amplitude of finger tapping) was also seen for a sample of 18PD patients ON medication. EEG data investigating the effect of vibration on oscillatory activity revealed a significant decrease in beta power (15–30 Hz) over the contralateral sensorimotor cortex at the onset and offset of 80 Hz vibration. This finding is consistent with a novel theoretical account of motor initiation, namely that modulating uncertainty of the proprioceptive afferent signal improves motor performance potentially by gating the incoming sensory signal and allowing for top‐down proprioceptive predictions.
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Affiliation(s)
- Antonella Macerollo
- Sobell Department of Motor Neuroscience and Movement Disorders, UCL, London, UK
| | - Clare Palmer
- Sobell Department of Motor Neuroscience and Movement Disorders, UCL, London, UK
| | - Thomas Foltynie
- Sobell Department of Motor Neuroscience and Movement Disorders, UCL, London, UK
| | - Prasad Korlipara
- Sobell Department of Motor Neuroscience and Movement Disorders, UCL, London, UK
| | - Patricia Limousin
- Sobell Department of Motor Neuroscience and Movement Disorders, UCL, London, UK
| | - Mark Edwards
- Sobell Department of Motor Neuroscience and Movement Disorders, UCL, London, UK
| | - James M Kilner
- Sobell Department of Motor Neuroscience and Movement Disorders, UCL, London, UK
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Swan CB, Schulte DJ, Brocker DT, Grill WM. Beta Frequency Oscillations in the Subthalamic Nucleus Are Not Sufficient for the Development of Symptoms of Parkinsonian Bradykinesia/Akinesia in Rats. eNeuro 2019; 6:ENEURO. [PMID: 31540998 DOI: 10.1523/ENEURO.0089-19.2019] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2019] [Revised: 07/30/2019] [Accepted: 09/11/2019] [Indexed: 11/21/2022] Open
Abstract
Substantial correlative evidence links the synchronized, oscillatory patterns of neural activity that emerge in Parkinson's disease (PD) in the beta (β) frequency range (13-30 Hz) with bradykinesia in PD. However, conflicting evidence exists, and whether these changes in neural activity are causal of motor symptoms in PD remains unclear. We tested the hypothesis that the synchronized β oscillations that emerge in PD are causal of symptoms of bradykinesia/akinesia. We designed patterns of stimulation that mimicked the temporal characteristics of single unit β bursting activity seen in PD animals and humans. We applied these β-patterned stimulation patterns along with continuous low-frequency and high-frequency controls to the subthalamic nucleus (STN) of intact and 6-OHDA-lesioned female Long-Evans and Sprague-Dawley rats. β-Patterned paradigms were superior to low-frequency controls at induction of β power in downstream substantia nigra reticulata (SNr) neurons and in ipsilateral motor cortex. However, we did not detect deleterious effects on motor performance across a wide battery of validated behavioral tasks. Our results suggest that β frequency oscillations (BFOs) may not be sufficient for the generation of bradykinesia/akinesia in PD.
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50
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McKinney WS, Wang Z, Kelly S, Khemani P, Lui S, White SP, Mosconi MW. Precision Sensorimotor Control in Aging FMR1 Gene Premutation Carriers. Front Integr Neurosci 2019; 13:56. [PMID: 31632248 PMCID: PMC6783559 DOI: 10.3389/fnint.2019.00056] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [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: 04/06/2019] [Accepted: 09/18/2019] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Individuals with premutation alleles of the FMR1 gene are at risk of developing fragile X-associated tremor/ataxia syndrome (FXTAS), a neurodegenerative condition affecting sensorimotor function. Information on quantitative symptom traits associated with aging in premutation carriers is needed to clarify neurodegenerative processes contributing to FXTAS. MATERIALS AND METHODS 26 FMR1 premutation carriers ages 44-77 years and 31 age-matched healthy controls completed rapid (2 s) and sustained (8 s) visually guided precision gripping tasks. Individuals pressed at multiple force levels to determine the impact of increasing the difficulty of sensorimotor actions on precision behavior. During initial pressing, reaction time, the rate at which individuals increased their force, the duration of pressing, and force accuracy were measured. During sustained gripping, the complexity of the force time series, force variability, and mean force were examined. During relaxation, the rate at which individuals decreased their force was measured. We also examined the relationships between visuomotor behavior and cytosine-guanine-guanine (CGG) repeat length and clinically rated FXTAS symptoms. RESULTS Relative to controls, premutation carriers showed reduced rates of initial force generation during rapid motor actions and longer durations of their initial pressing with their dominant hand. During sustained force, premutation carriers demonstrated reduced force complexity, though this effect was specific to younger premutation carries during dominant hand pressing and was more severe for younger relative to older premutation carriers at low and medium force levels. Increased reaction time and lower sustained force complexity each were associated with greater CGG repeat length for premutation carriers. Increased reaction time and increased sustained force variability were associated with more severe clinically rated FXTAS symptoms. CONCLUSION Overall our findings suggest multiple sensorimotor processes are disrupted in aging premutation carriers, including initial force control guided by feedforward mechanisms and sustained sensorimotor behaviors guided by sensory feedback control processes. Results indicating that sensorimotor issues in aging premutation carriers relate to both greater CGG repeat length and clinically rated FXTAS symptoms suggest that quantitative tests of precision sensorimotor ability may serve as key targets for monitoring FXTAS risk and progression.
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Affiliation(s)
- Walker S. McKinney
- Clinical Child Psychology Program, Life Span Institute and Kansas Center for Autism Research and Training (K-CART), University of Kansas, Lawrence, KS, United States
| | - Zheng Wang
- Department of Occupational Therapy, University of Florida, Gainesville, FL, United States
| | - Shannon Kelly
- Clinical Child Psychology Program, Life Span Institute and Kansas Center for Autism Research and Training (K-CART), University of Kansas, Lawrence, KS, United States
| | - Pravin Khemani
- Department of Neurology, Swedish Neuroscience Institute, Seattle, WA, United States
| | - Su Lui
- Department of Radiology, Huaxi Magnetic Resonance Research Center, West China Hospital of Sichuan University, Chengdu, China
| | - Stormi P. White
- Department of Pediatrics, Marcus Autism Center, Emory University School of Medicine, Atlanta, GA, United States
| | - Matthew W. Mosconi
- Clinical Child Psychology Program, Life Span Institute and Kansas Center for Autism Research and Training (K-CART), University of Kansas, Lawrence, KS, United States
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