scholarly journals Dizziness in Parkinson’s disease patients is associated with vestibular function

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Jeong-Ho Park ◽  
Suk Yun Kang
Keyword(s):  
Parkinson’S Disease ◽  
Parkinson's Disease ◽  
Orthostatic Hypotension ◽  
Rating Scale ◽  
Treatment Plan ◽  
Vestibular Function ◽  
Vestibular Evoked Myogenic Potentials ◽  
Yahr Stage ◽  
The Right ◽  
And Function

AbstractDizziness is common in Parkinson’s disease (PD) patients. It is known that orthostatic hypotension (OH) is the main cause of such dizziness, but even without OH, quite a few PD patients complain of dizziness in the clinic. It can be regarded as non-specific because most of these patients have no neurological abnormalities. We hypothesized that this type of dizziness would be associated with vestibular function, although included patients did not have clinically confirmed vestibulopathy. We studied 84 patients without OH among 121 PD patients. Their clinical features and function were compared between patients with and without dizziness. Hoehn and Yahr stage (H&Y stage), the Unified Parkinson's Disease Rating Scale (UPDRS) part III, the Korean version of the Mini-Mental State Examination (K-MMSE), education years, disease duration, total levodopa equivalent daily dose (LEDD), the presence of dizziness, the dizziness severity, and orthostatic hypotension were tested. Vestibular evoked myogenic potentials (VEMPs) were used to characterize vestibular function. Ocular (oVEMPs) and cervical (cVEMPs) were recorded. oVEMPs in the right side showed significantly reduced potentials (p = 0.016) in PD patients with dizziness, but cVEMPs did not (all ps > 0.2). Bilateral absent oVEMP responses were more common in PD patients with dizziness (p = 0.022), but the frequencies of bilateral absent cVEMP responses were not different between the dizzy and non-dizzy groups (p = 0.898). Dizziness in PD patients without orthostatic hypotension may be associated with vestibular hypofunction. Our results provide evidence that can aid clinicians when making a treatment plan for patients with dizziness. i.e., strategies to enhance reduced vestibular function may be helpful, but this suggestion remains to be evaluated.

scholarly journals Motoric impairment versus iron deposition gradient in the subthalamic nucleus in Parkinson’s disease

2020 ◽  
pp. 1-7
Author(s):  
Weiyuan Huang ◽  
Richard Ogbuji ◽  
Liangdong Zhou ◽  
Lingfei Guo ◽  
Yi Wang ◽  
...  
Keyword(s):  
Parkinson’S Disease ◽  
Parkinson's Disease ◽  
Subthalamic Nucleus ◽  
Rating Scale ◽  
Statistical Tests ◽  
Motor Impairment ◽  
Iron Deposition ◽  
Severe Motor ◽  
Severe Motor Impairment ◽  
The Right

OBJECTIVEThe objective of this study was to investigate the correlation between the quantitative susceptibility mapping (QSM) signal gradient of the subthalamic nucleus (STN) and motor impairment in patients with Parkinson’s disease (PD).METHODSAll PD patients who had undergone QSM MRI for presurgical deep brain stimulation (DBS) planning were eligible for inclusion in this study. The entire STN and its three functional subdivisions, as well as the adjacent white matter (WM), were segmented and measured. The QSM value difference between the entire STN and adjacent WM (STN-WM), between the limbic and associative regions of the STN (L-A), and between the associative and motor regions of the STN (A-M) were obtained as measures of gradient and were input into an unsupervised k-means clustering algorithm to automatically categorize the overall boundary distinctness between the STN and adjacent WM and between STN subdivisions (gradient blur [GB] and gradient sharp [GS] groups). Statistical tests were performed to compare clinical and image measurements for discrimination between GB and GS groups.RESULTSOf the 39 study patients, 19 were categorized into the GB group and 20 into the GS group, based on quantitative cluster analysis. The GB group had a significantly higher presurgical off-medication Unified Parkinson’s Disease Rating Scale Part III score (51.289 ± 20.741) than the GS group (38.5 ± 16.028; p = 0.037). The GB group had significantly higher QSM values for the STN and its three subdivisions and adjacent WM than those for the GS group (p < 0.01). The GB group also demonstrated a significantly higher STN-WM gradient in the right STN (p = 0.01). The GB group demonstrated a significantly lower L-A gradient in both the left and the right STN (p < 0.02).CONCLUSIONSAdvancing PD with more severe motor impairment leads to more iron deposition in the STN and adjacent WM, as shown in the QSM signal. Loss of the STN inner QSM signal gradient should be considered as an image marker for more severe motor impairment in PD patients.

scholarly journals Pain in Parkinson's disease

2009 ◽  
Vol 67 (3a) ◽  
pp. 591-594 ◽  
Author(s):  
Grace Helena Letro ◽  
Elizabeth M.A.B. Quagliato ◽  
Maura Aparecida Viana
Keyword(s):  
Parkinson’S Disease ◽  
Parkinson's Disease ◽  
Beck Depression Inventory ◽  
Rating Scale ◽  
Yahr Stage ◽  
Disease Rating

Pain may precede the diagnosis in Parkinson's disease (PD). The goal of this study was to assess the pain in a group of 20 females and 30 males with PD, after excluding co-morbidities as causes. It was used the following tools: Unified Parkinson's Disease Rating Scale, McGill questionnaire and Beck Depression Inventory. In 27 patients (54%), the pain was associated with PD, occurring in 22 (44%) in the off period and 5 (10%) in both on and off periods. The off period resulted in an increased frequency of pain, which was related to stiffness. There was no association between pain and tremor in off period, neither between pain and Modified Hoehn and Yahr stage, nor the Schwab and England scale. It was not observed an association between pain and depression, neither between pain and dyskinesia. It was noticed the improvement in pain in 16 patients with levodopa (59.26%).

scholarly journals Neurofeedback-guided kinesthetic motor imagery training in Parkinson's disease: Randomized trial

2022 ◽  
Author(s):  
Sule Tinaz ◽  
Serageldin Kamel ◽  
Sai S Aravala ◽  
Mohamed Elfil ◽  
Ahmed Bayoumi ◽  
...  
Keyword(s):  
Parkinson’S Disease ◽  
Parkinson's Disease ◽  
Functional Connectivity ◽  
Motor Function ◽  
Motor Imagery ◽  
Resting State ◽  
Visual Imagery ◽  
Body Awareness ◽  
Yahr Stage ◽  
The Right

Background: Parkinson's disease (PD) causes difficulty with maintaining the speed, size, and vigor of movements, especially when they are internally generated. We previously proposed that the insula is important in motivating intentional movement via its connections with the dorsomedial frontal cortex (dmFC). We demonstrated that subjects with PD can increase the right insula-dmFC functional connectivity using fMRI-based neurofeedback (NF) combined with kinesthetic motor imagery (MI). The current study is a randomized clinical trial testing whether NF-guided kinesthetic MI training can improve motor performance and increase task-based and resting-state right insula-dmFC functional connectivity in subjects with PD. Methods: We assigned nondemented subjects with mild PD (Hoehn & Yahr stage ≤ 3) to the experimental kinesthetic MI with NF (MI-NF, n=22) and active control visual imagery (VI, n=22) groups. Only the MI-NF group received NF-guided MI training (10-12 runs). The NF signal was based on the right insula-dmFC functional connectivity strength. All subjects also practiced their respective imagery tasks at home daily for 4 weeks. Post-training changes in 1) task-based and resting-state right insula-dmFC functional connectivity were the imaging outcomes, and 2) MDS-UPDRS motor exam and motor function scores were the clinical outcomes. Results: The MI-NF group did not show significant NF regulation and was not significantly different from the VI group in any of the imaging or clinical outcome measures. The MI-NF group reported subjective improvement in kinesthetic body awareness. There was significant and comparable improvement only in motor function scores in both groups. This improvement correlated with NF regulation of the right insula-dmFC functional connectivity only in the MI-NF group. Both groups showed specific training effects in whole-brain functional connectivity with distinct neural circuits supporting kinesthetic motor and visual imagery (exploratory outcome). Conclusions: The functional connectivity-based NF regulation was unsuccessful in our cohort with mild PD. However, kinesthetic MI practice by itself or in combination with other imagery techniques is a promising tool in motor rehabilitation in PD.

scholarly journals Confirmatory Factor Analysis of the Motor Unified Parkinson’s Disease Rating Scale

2012 ◽  
Vol 2012 ◽  
pp. 1-10 ◽  
Author(s):  
Stefanie D. Vassar ◽  
Yvette M. Bordelon ◽  
Ron D. Hays ◽  
Natalie Diaz ◽  
Rebecca Rausch ◽  
...  
Keyword(s):  
Parkinson’S Disease ◽  
Parkinson's Disease ◽  
Factor Analysis ◽  
Confirmatory Factor Analysis ◽  
Symptom Severity ◽  
Rating Scale ◽  
Confirmatory Factor ◽  
Disease Rating ◽  
The Right ◽  
Gait Posture

The motor examination section of the unified Parkinson’s disease rating scale (UPDRS) is widely used in research but few studies have examined whether subscales exist that tap relatively distinct motor abnormalities. We analyzed data from 193 persons enrolled in a population-based study in Central California. Patients were examined after overnight PD medication washout (“OFF” state) and approximately one hour after taking medication (“ON” state). We performed confirmatory factor analysis of the UPDRS for OFF and ON state examinations; correlations, reliability, and relative validity of resulting subscales were evaluated. A model with five factors (gait/posture, tremor, rigidity, bradykinesia affecting the left extremities, bradykinesia affecting the right extremities) fit the data well, with similar results for OFF and ON states. Internal consistency reliability coefficients were 0.90 or higher for all subscales. The gait/posture subscale most strongly discriminated across levels of patient reported PD symptom severity and of how PD affects them on a daily basis. Compared to the right sided bradykinesia subscale, the left sided bradykinesia subscale had higher discrimination across levels of self-reported PD symptom severity and functional impairment. This supports motor UPDRS containing multiple subscales that can be analyzed separately and provide information distinct from the total score that may be useful in clinical studies.

Stimulation of the Subthalamic Nucleus in Parkinson's Disease Does Not Produce Striatal Dopamine Release

Neurosurgery ◽  
2003 ◽  
Vol 53 (5) ◽  
pp. 1095-1105 ◽  
Author(s):  
Aviva Abosch ◽  
Shitij Kapur ◽  
Anthony E. Lang ◽  
Doug Hussey ◽  
Elspeth Sime ◽  
...  
Keyword(s):  
Parkinson’S Disease ◽  
Parkinson's Disease ◽  
Dopamine Release ◽  
Rating Scale ◽  
Striatal Dopamine ◽  
Striatal Dopamine Release ◽  
Before And After ◽  
Disease Rating ◽  
The Right ◽  
Stimulation Of

Abstract OBJECTIVE The subthalamic nucleus (STN) is a target in the surgical treatment of Parkinson's disease (PD). The mechanism by which electrical stimulation of the STN ameliorates symptoms of PD remains unknown. One consistent aspect of STN stimulation is the ability to reduce the dosage of dopaminergic medications; sometimes they can be eliminated altogether. Furthermore, nigrostriatal projection axons are apposed to the dorsal surface of the STN and are likely affected by the application of current in this region. We sought to determine whether STN stimulation could release endogenous striatal dopamine. METHODS Five patients with PD, who had previously undergone surgical implantation of bilateral STN stimulators, underwent [11C]raclopride positron emission tomographic scanning. l-dopa was withheld for 12 hours, and both stimulators were turned off 9 hours before scanning. We assayed for striatal dopamine release by measuring radioligand displacement as a consequence of turning on the right STN stimulator after 45 minutes of a 90-minute [11C]raclopride infusion. Patients were evaluated with the motor section of the Unified Parkinson's Disease Rating Scale before and after the studies. RESULTS Comparisons between the right and left striata, before and after right STN stimulation, demonstrated no significant differences in [11C]raclopride binding, despite significant improvements in Unified Parkinson's Disease Rating Scale motor scores with unilateral stimulation (mean improvement, 26.0 ± 16.4%; P &lt; 0.05). This finding was also noted when the striatum was partitioned into dorsal and ventral caudate and putamen and the four regions were analyzed separately. CONCLUSION Our results suggest that STN stimulation does not mediate its anti-PD effects via the release of dopamine, as assessed with [11C]raclopride displacement.

scholarly journals Pisa Syndrome in Parkinson’s Disease: Evidence for Bilateral Vestibulospinal Dysfunction

2018 ◽  
Vol 2018 ◽  
pp. 1-6 ◽  
Author(s):  
Giulia Di Lazzaro ◽  
Tommaso Schirinzi ◽  
Maria Pia Giambrone ◽  
Roberta Di Mauro ◽  
Maria Giuseppina Palmieri ◽  
...  
Keyword(s):  
Parkinson’S Disease ◽  
Parkinson's Disease ◽  
Rating Scale ◽  
Test Validity ◽  
Vestibular Evoked Myogenic Potentials ◽  
Multinomial Regression ◽  
Chi Square ◽  
Pisa Syndrome ◽  
Significant Impairment ◽  
Disease Rating

Introduction. Pisa syndrome (PS) is a postural complication of Parkinson’s disease (PD). Yet, its pathophysiology remains unclear, although a multifactorial component is probable. Cervical vestibular evoked myogenic potentials (cVEMPs) explore vestibulospinal pathway, but they have not been measured yet in PD patients with PS (PDPS) to assess a potential vestibular impairment. Materials and Methods. We enrolled 15 PD patients, 15 PDPS patients, and 30 healthy controls (HCs). They underwent neurological examination and were examined with Unified Parkinson’s Disease Rating Scale II-III (UPDRSII-III), audiovestibular workup, and cVEMP recordings. Data were analysed with Chi-square, one-way ANOVA, multinomial regression, nonparametric, and Spearman’s tests. Results. cVEMPs were significantly impaired in both PD and PDPS compared with HCs. PDPS exhibited more severe cVEMP abnormalities with prevalent bilateral loss of potentials, compared with the PD group, in which a prevalent unilateral loss was instead observed. No clinical-neurophysiological correlations emerged. Conclusions. Differently from HC, cVEMPs are altered in PD. Severity of cVEMPs alterations increases from PD without PS to PDPS, suggesting an involvement of vestibulospinal pathway in the pathophysiology of PS. Our results provide evidence for a significant impairment of cVEMPs in PDPS patients and encourage further studies to test validity of cVEMPs as diagnostic and prognostic biomarkers of PD progression.

scholarly journals Prefrontal dysfunction following unilateral posteroventral pallidotomy in Parkinson's disease

1999 ◽  
Vol 6 (4) ◽  
pp. E2
Author(s):  
Tetsuo Yokoyama ◽  
Yoko Imamura ◽  
Kenji Sugiyama ◽  
Shigeru Nishizawa ◽  
Naoki Yokota ◽  
...  
Keyword(s):  
Parkinson’S Disease ◽  
Parkinson's Disease ◽  
Cognitive Function ◽  
Digit Span ◽  
Preoperative Evaluation ◽  
Japanese Version ◽  
Word Fluency ◽  
Yahr Stage ◽  
Posteroventral Pallidotomy ◽  
The Right

Object Pre- and postoperative cognitive function were evaluated in 25 patients with Parkinson's disease (PD) who underwent unilateral posteroventral pallidotomy (PVP) to clarify the effects of this operation on cognitive function. Methods Cognitive function was assessed before surgery and 1 month and 3 months afterward by using a battery of neuropsychological tests consisting of orientation, digit span (forward and backward), digit learning, 5-minute memory of five words, similarities, serial sevens, animal name listing, and the kana pick-out test, as well as the Japanese version of the Mini-Mental State. Preoperative evaluation revealed that patients experienced difficulties in performing the neuropsychological tasks of reasoning and abstraction, working memory of numerals, word fluency, and concept formation compared with 36 healthy volunteers (p < 0.05). A simple regression analysis showed strong relationships in a negative fashion between preoperative (r = 0.81, p = 0.002) and 1-month (r = 0.79, p = 0.0059) and 3-month (r = 0.85, p = 0.0016) postoperative gross-total scores and Hoehn and Yahr staging. Preoperative and postoperative scores at 1 month and 3 months were analyzed by analysis of variance, but only the Fisher's post hoc test revealed the source of difference. All tasks except orientation (p = 0.0292) were unchanged in the 10 patients who underwent surgery on the right side. The scores for this task at 1 month postsurgery were significantly lower (p = 0.0203) but improved to preoperative values by 3 months. In the 15 patients who underwent surgery on the left side significant differences among tasks were revealed for serial sevens (p = 0.0471) and animal naming (p = 0.0425). The scores for these tasks were significantly lower at 1 month postoperatively (p = 0.0431 for serial sevens and p = 0.0408 for animal naming), but improved by 3 months after the operation. Conclusions The present data revealed that cognitive dysfunction in patients with PD relates to advancement of Hoehn and Yahr stage, but PVP is not associated with significant long-lasting cognitive deficits.

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