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Heß T, Themann P, Oehlwein C, Milani TL. Does Impaired Plantar Cutaneous Vibration Perception Contribute to Axial Motor Symptoms in Parkinson's Disease? Effects of Medication and Subthalamic Nucleus Deep Brain Stimulation. Brain Sci 2023; 13:1681. [PMID: 38137129 PMCID: PMC10742284 DOI: 10.3390/brainsci13121681] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2023] [Revised: 11/28/2023] [Accepted: 12/03/2023] [Indexed: 12/24/2023] Open
Abstract
OBJECTIVE To investigate whether impaired plantar cutaneous vibration perception contributes to axial motor symptoms in Parkinson's disease (PD) and whether anti-parkinsonian medication and subthalamic nucleus deep brain stimulation (STN-DBS) show different effects. METHODS Three groups were evaluated: PD patients in the medication "on" state (PD-MED), PD patients in the medication "on" state and additionally "on" STN-DBS (PD-MED-DBS), as well as healthy subjects (HS) as reference. Motor performance was analyzed using a pressure distribution platform. Plantar cutaneous vibration perception thresholds (VPT) were investigated using a customized vibration exciter at 30 Hz. RESULTS Motor performance of PD-MED and PD-MED-DBS was characterized by greater postural sway, smaller limits of stability ranges, and slower gait due to shorter strides, fewer steps per minute, and broader stride widths compared to HS. Comparing patient groups, PD-MED-DBS showed better overall motor performance than PD-MED, particularly for the functional limits of stability and gait. VPTs were significantly higher for PD-MED compared to those of HS, which suggests impaired plantar cutaneous vibration perception in PD. However, PD-MED-DBS showed less impaired cutaneous vibration perception than PD-MED. CONCLUSIONS PD patients suffer from poor motor performance compared to healthy subjects. Anti-parkinsonian medication in tandem with STN-DBS seems to be superior for normalizing axial motor symptoms compared to medication alone. Plantar cutaneous vibration perception is impaired in PD patients, whereas anti-parkinsonian medication together with STN-DBS is superior for normalizing tactile cutaneous perception compared to medication alone. Consequently, based on our results and the findings of the literature, impaired plantar cutaneous vibration perception might contribute to axial motor symptoms in PD.
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Affiliation(s)
- Tobias Heß
- Department of Human Locomotion, Chemnitz University of Technology, 09126 Chemnitz, Germany
| | - Peter Themann
- Department of Neurology and Parkinson, Clinic at Tharandter Forest, 09633 Halsbruecke, Germany
| | - Christian Oehlwein
- Neurological Outpatient Clinic for Parkinson Disease and Deep Brain Stimulation, 07551 Gera, Germany
| | - Thomas L. Milani
- Department of Human Locomotion, Chemnitz University of Technology, 09126 Chemnitz, Germany
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Pongmala C, Roytman S, van Emde Boas M, Dickinson O, Kanel P, Bohnen NI. Composite measures of motor performance and self-efficacy are better determinants of postural instability and gait difficulties than individual clinical measures in Parkinson's disease. Parkinsonism Relat Disord 2023; 107:105251. [PMID: 36566525 PMCID: PMC10028594 DOI: 10.1016/j.parkreldis.2022.105251] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2022] [Revised: 12/15/2022] [Accepted: 12/16/2022] [Indexed: 12/24/2022]
Abstract
BACKGROUND Postural instability and gait difficulties (PIGD) are a significant cause of disability and loss of quality of life (QoL) in Parkinson's Disease. Most research on clinical predictors of PIGD measures have focused on individual clinical often motor performance variables, However, PIGD motor features often result in fear of falling (FoF) lowering a patient's mobility self-efficacy. The purpose of this study was to assess composite measures of motor and self-efficacy determinants PIGD motor features in PD and compare these to analysis of individual clinical metrics. METHODS 75 PD participants underwent detailed motor and non-motor test batteries. Principal component analysis (PCA) was used to identify clusters of covarying correlates of slow walking, imbalance, falls, freezing of gait, FoG and compare these to traditional univariate analyses. RESULTS A single PCA-derived composite measure of motor performance and self-efficacy of mobility was the most robust determinant of all PIGD motor features except for falls. In contrast, analysis of the individual clinical variables showed more limited and diverging findings, including evidence of better cognitive performance but more severe motor parkinsonian ratings in the fall group. CONCLUSION There are robust associations between composite measures of motor performance and self-efficacy of mobility and all PIGD motor features except for falls. Univariate analysis of individual clinical measures showed limited correlates of PIGD motor features. Patient's own perception of motor performance, FoF, and QoL deserve more attention as PIGD therapeutic targets in PD.
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Affiliation(s)
- Chatkaew Pongmala
- Department of Radiology, University of Michigan, Ann Arbor, MI, USA; Functional Neuroimaging, Cognitive, and Mobility Laboratory, Departments of Radiology and Neurology, University of Michigan, Ann Arbor, MI, USA; Morris K. Udall Center of Excellence for Parkinson's Disease Research, University of Michigan, Ann Arbor, MI, USA.
| | - Stiven Roytman
- Department of Radiology, University of Michigan, Ann Arbor, MI, USA; Functional Neuroimaging, Cognitive, and Mobility Laboratory, Departments of Radiology and Neurology, University of Michigan, Ann Arbor, MI, USA
| | - Miriam van Emde Boas
- Department of Radiology, University of Michigan, Ann Arbor, MI, USA; Functional Neuroimaging, Cognitive, and Mobility Laboratory, Departments of Radiology and Neurology, University of Michigan, Ann Arbor, MI, USA; Morris K. Udall Center of Excellence for Parkinson's Disease Research, University of Michigan, Ann Arbor, MI, USA
| | - Olivia Dickinson
- Department of Radiology, University of Michigan, Ann Arbor, MI, USA; Functional Neuroimaging, Cognitive, and Mobility Laboratory, Departments of Radiology and Neurology, University of Michigan, Ann Arbor, MI, USA
| | - Prabesh Kanel
- Department of Radiology, University of Michigan, Ann Arbor, MI, USA; Functional Neuroimaging, Cognitive, and Mobility Laboratory, Departments of Radiology and Neurology, University of Michigan, Ann Arbor, MI, USA; Morris K. Udall Center of Excellence for Parkinson's Disease Research, University of Michigan, Ann Arbor, MI, USA; Parkinson's Foundation Research Center of Excellence, University of Michigan, Ann Arbor, MI, USA
| | - Nicolaas I Bohnen
- Department of Radiology, University of Michigan, Ann Arbor, MI, USA; Department of Neurology, University of Michigan, Ann Arbor, MI, USA; Functional Neuroimaging, Cognitive, and Mobility Laboratory, Departments of Radiology and Neurology, University of Michigan, Ann Arbor, MI, USA; Morris K. Udall Center of Excellence for Parkinson's Disease Research, University of Michigan, Ann Arbor, MI, USA; Parkinson's Foundation Research Center of Excellence, University of Michigan, Ann Arbor, MI, USA; Neurology Service and GRECC, VA Ann Arbor Healthcare System, Ann Arbor, MI, USA
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Kohat AK, Ng SYE, Wong ASY, Chia NSY, Choi X, Heng DL, Li W, Ng HL, Chua ST, Neo SXM, Xu Z, Tay KY, Au WL, Tan EK, Tan LCS. Stability of MDS-UPDRS Motor Subtypes Over Three Years in Early Parkinson's Disease. Front Neurol 2021; 12:704906. [PMID: 34630281 PMCID: PMC8498197 DOI: 10.3389/fneur.2021.704906] [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: 05/04/2021] [Accepted: 08/25/2021] [Indexed: 11/18/2022] Open
Abstract
Background: Various classifications have been proposed to subtype Parkinson's disease (PD) based on their motor phenotypes. However, the stability of these subtypes has not been properly evaluated. Objective: The goal of this study was to understand the distribution of PD motor subtypes, their stability over time, and baseline factors that predicted subtype stability. Methods: Participants (n = 170) from two prospective cohorts were included: the Early PD Longitudinal Singapore (PALS) study and the National Neuroscience Institute Movement Disorders Database. Early PD patients were classified into tremor-dominant (TD), postural instability and gait difficulty (PIGD), and indeterminate subtypes according to the Movement Disorder Society's Unified PD Rating Scale (MDS-UPDRS) criteria and clinically evaluated for three consecutive years. Results: At baseline, 60.6% patients were TD, 12.4% patients were indeterminate, and 27.1% patients were PIGD subtypes (p < 0.05). After 3 years, only 62% of patients in TD and 50% of patients in PIGD subtypes remained stable. The mean levodopa equivalent daily dose (LEDD) was higher in the PIGD subtype (276.92 ± 232.91 mg; p = 0.01). Lower LEDD [p < 0.05, odds ratio (OR) 0.99, 95% confidence interval (CI): 0.98–0.99] and higher TD/PIGD ratios (p < 0.05, OR 1.77, 95% CI: 1.29–2.43) were independent predictors of stability of TD subtype with an area under the curve (AUC) of 0.787 (95%CI: 0.669–0.876), sensitivity = 57.8%, and specificity = 89.7%. Conclusion: Only 50–62% of PD motor subtypes as defined by MDS-UPDRS remained stable over 3 years. TD/PIGD ratio and baseline LEDD were independent predictors for TD subtype stability over 3 years.
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Affiliation(s)
- Abhijeet K Kohat
- Department of Neurology, National Neuroscience Institute, Singapore, Singapore.,Parkinson's Disease and Movement Disorders Centre (Parkinson Foundation's International Center of Excellence), National Neuroscience Institute, Singapore, Singapore
| | - Samuel Y E Ng
- Department of Neurology, National Neuroscience Institute, Singapore, Singapore.,Parkinson's Disease and Movement Disorders Centre (Parkinson Foundation's International Center of Excellence), National Neuroscience Institute, Singapore, Singapore
| | - Aidan S Y Wong
- Department of Neurology, National Neuroscience Institute, Singapore, Singapore.,Parkinson's Disease and Movement Disorders Centre (Parkinson Foundation's International Center of Excellence), National Neuroscience Institute, Singapore, Singapore
| | - Nicole S Y Chia
- Department of Neurology, National Neuroscience Institute, Singapore, Singapore.,Parkinson's Disease and Movement Disorders Centre (Parkinson Foundation's International Center of Excellence), National Neuroscience Institute, Singapore, Singapore
| | - Xinyi Choi
- Department of Neurology, National Neuroscience Institute, Singapore, Singapore.,Parkinson's Disease and Movement Disorders Centre (Parkinson Foundation's International Center of Excellence), National Neuroscience Institute, Singapore, Singapore
| | - Dede L Heng
- Parkinson's Disease and Movement Disorders Centre (Parkinson Foundation's International Center of Excellence), National Neuroscience Institute, Singapore, Singapore.,Duke-NUS Graduate Medical School, Singapore, Singapore
| | - Wei Li
- Department of Neurology, National Neuroscience Institute, Singapore, Singapore.,Parkinson's Disease and Movement Disorders Centre (Parkinson Foundation's International Center of Excellence), National Neuroscience Institute, Singapore, Singapore
| | - Hwee-Lan Ng
- Department of Neurology, National Neuroscience Institute, Singapore, Singapore.,Parkinson's Disease and Movement Disorders Centre (Parkinson Foundation's International Center of Excellence), National Neuroscience Institute, Singapore, Singapore
| | - Shu-Ting Chua
- Department of Neurology, National Neuroscience Institute, Singapore, Singapore.,Parkinson's Disease and Movement Disorders Centre (Parkinson Foundation's International Center of Excellence), National Neuroscience Institute, Singapore, Singapore
| | - Shermyn X M Neo
- Department of Neurology, National Neuroscience Institute, Singapore, Singapore.,Parkinson's Disease and Movement Disorders Centre (Parkinson Foundation's International Center of Excellence), National Neuroscience Institute, Singapore, Singapore
| | - Zheyu Xu
- Department of Neurology, National Neuroscience Institute, Singapore, Singapore.,Parkinson's Disease and Movement Disorders Centre (Parkinson Foundation's International Center of Excellence), National Neuroscience Institute, Singapore, Singapore
| | - Kay-Yaw Tay
- Department of Neurology, National Neuroscience Institute, Singapore, Singapore.,Parkinson's Disease and Movement Disorders Centre (Parkinson Foundation's International Center of Excellence), National Neuroscience Institute, Singapore, Singapore.,Duke-NUS Graduate Medical School, Singapore, Singapore
| | - Wing-Lok Au
- Department of Neurology, National Neuroscience Institute, Singapore, Singapore.,Parkinson's Disease and Movement Disorders Centre (Parkinson Foundation's International Center of Excellence), National Neuroscience Institute, Singapore, Singapore.,Duke-NUS Graduate Medical School, Singapore, Singapore
| | - Eng-King Tan
- Department of Neurology, National Neuroscience Institute, Singapore, Singapore.,Parkinson's Disease and Movement Disorders Centre (Parkinson Foundation's International Center of Excellence), National Neuroscience Institute, Singapore, Singapore.,Duke-NUS Graduate Medical School, Singapore, Singapore
| | - Louis C S Tan
- Department of Neurology, National Neuroscience Institute, Singapore, Singapore.,Parkinson's Disease and Movement Disorders Centre (Parkinson Foundation's International Center of Excellence), National Neuroscience Institute, Singapore, Singapore.,Duke-NUS Graduate Medical School, Singapore, Singapore
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