Balance Dysfunction in Parkinson’s Disease: The Role of Posturography in Developing a Rehabilitation Program

Balance dysfunction (BD) in Parkinson’s disease (PD) is a disabling symptom, difficult to treat and predisposing to falls. The dopaminergic drugs or deep brain stimulation does not always provide significant improvements of BD and rehabilitative approaches have also failed to restore this condition. In this study, we investigated the suitability of quantitative posturographic indicators to early identify patients that could develop disabling BD. Parkinsonian patients not complaining of a subjective BD and controls were tested using a posturographic platform (PP) with open eyes (OE) and performing a simple cognitive task [counting (OEC)]. We found that patients show higher values of total standard deviation (SD) of body sway and along the medio-lateral (ML) axis during OE condition. Furthermore, total and ML SD of body sway during OE condition and total SD of body sway with OEC were higher than controls also in a subgroup of patients with normal Berg Balance Scale. We conclude that BD in Parkinsonian patients can be discovered before its appearance using a PP and that these data may allow developing specific rehabilitative treatment to prevent or delay their onset.

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Dual task performance: a comparison between healthy elderly individuals and those with Parkinson’s disease

Fisioterapia em Movimento ◽

10.1590/0103-5150.028.002.ao05 ◽

2015 ◽

Vol 28 (2) ◽

pp. 251-258 ◽

Cited By ~ 5

Author(s):

Eduardo Nascimento Floriano ◽

Jacqueline Frazão Alves ◽

Isabela Andrelino de Almeida ◽

Roger Burgo de Souza ◽

Gustavo Christofoletti ◽

...

Keyword(s):

Parkinson’S Disease ◽

Parkinson's Disease ◽

Functional Performance ◽

Cognitive Task ◽

The Elderly ◽

Berg Balance Scale ◽

Dual Tasks ◽

Healthy Elderly ◽

Significant Difference ◽

And Performance

Introduction The dual tasks (DT) is learned during the whole life and a prerequisite in functional performance in different activities of daily living. Healthy elderly have reduced ability to perform motor activities and cognitive tasks simultaneously, compared to young adults. Parkinson’s disease (PD) is the second most common neurodegenerative disease in the elderly and classic motor symptoms coexist with prejudice in cognitive domains. Objective To compare balance, gait and performance in dual tasks of individuals with Parkinson’s disease and healthy elderly. Material and method Transversal study consisted of 21 individuals with PD, classified between 1.5 to 3 in Hoehn and Yahr scale and 21 healthy individuals. To evaluate the performance on simple tasks and dual tasks the participants were submitted to five simple tasks (motor) and each was associated with a cognitive task, featuring a DT. To balance and gait evaluation was used the following instruments: Berg Balance Scale, Tinetti Scale and Dynamic Gait Index. Results In respect to gait and performance in dual tasks, there was a statistically significant difference with the worst performance for the group of individuals with PD. Conclusion It was found that the group of elderly people with PD has lower performance in the execution of concurrent tasks when compared with healthy elderly, so the DT can be introduced in rehabilitation programs to improve the performance of these patients.

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Can a Positive Allosteric Modulation of GABAergic Receptors Improve Motor Symptoms in Patients with Parkinson’s Disease? The Potential Role of Zolpidem in the Treatment of Parkinson’s Disease

Parkinson s Disease ◽

10.1155/2016/2531812 ◽

2016 ◽

Vol 2016 ◽

pp. 1-14 ◽

Cited By ~ 3

Author(s):

Antonio Daniele ◽

Francesco Panza ◽

Antonio Greco ◽

Giancarlo Logroscino ◽

Davide Seripa

Keyword(s):

Parkinson’S Disease ◽

Parkinson's Disease ◽

Randomized Clinical Trials ◽

Allosteric Modulation ◽

Motor Symptoms ◽

Dopaminergic Drugs ◽

Internal Globus Pallidus ◽

Gabaergic Neurotransmission ◽

Increased Activity

At present, patients with advanced Parkinson’s disease (PD) are unsatisfactorily controlled by currently used anti-Parkinsonian dopaminergic drugs. Various studies suggest that therapeutic strategies based on nondopaminergic drugs might be helpful in PD. Zolpidem, an imidazopyridine widely used as sleep inducer, shows high affinity only forGABAAreceptors containing theα-1 subunit and facilitates GABAergic neurotransmission through a positive allosteric modulation ofGABAAreceptors. Various observations, although preliminary, consistently suggest that in PD patients zolpidem may induce beneficial (and sometimes remarkable) effects on motor symptoms even after single doses and may also improve dyskinesias. Since a high density of zolpidem binding sites is in the two main output structures of the basal ganglia which are abnormally overactive in PD (internal globus pallidus, GPi, and substantia nigra pars reticulata, SNr), it was hypothesized that in PD patients zolpidem may induce throughGABAAreceptors an inhibition of GPi and SNr (and, possibly, of the subthalamic nucleus also), resulting in an increased activity of motor cortical areas (such as supplementary motor area), which may give rise to improvement of motor symptoms of PD. Randomized clinical trials are needed in order to assess the efficacy, safety, and tolerability of zolpidem in treating motor symptoms of PD.

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Drug treatment of Parkinson's disease

Dialogues in Clinical Neuroscience ◽

10.31887/dcns.2004.6.3/akorczyn ◽

2004 ◽

Vol 6 (3) ◽

pp. 315-322 ◽

Cited By ~ 2

Keyword(s):

Parkinson’S Disease ◽

Parkinson's Disease ◽

Initial Therapy ◽

Dopaminergic Drugs ◽

Advanced Stages ◽

Receptor Blockers ◽

Extrapyramidal Effects ◽

Specific Symptoms

Parkinson's disease (PD) is a common neurodegenerative disease. While its cause remains elusive, much progress has been made regarding its treatment. Available drugs have a good symptomatic effect, but none has yet been shown to slow the progression of the disease in humans. The most efficacious drug is levodopa, but it remains unclear whether the symptomatic benefit is associated with neurotoxic effects and long-term deterioration. The long-term problem associated with levodopa is the appearance of dyskinesias, which is significantly delayed among patients treated with dopamine agonists as initial therapy. Less clear is the role of other drugs in PD, such as monoamine oxidase inhibitors (MAOIs), including selegiline and rasagiline, the putative N-meihyl-o-aspartaie (NMDA) receptor antagonists amantadine and memantine, and the muscarinic receptor blockers. All these may be used as initial therapy and delay the use of dopaminergic drugs, or can be added later to reduce specific symptoms (tremor or dyskinesias). Advanced PD is frequently associated with cognitive decline. To some extent, this can be helped by treatment with cholinesterase inhibitors such as rivastigmine. Similarly, hallucinations and delusions affect PD patients in the advanced stages of their disease. The use of classical neuroleptic drugs in these patients is contraindicated because of their extrapyramidal effects, but atypical drugs, and particularly clozapine, are very helpful. The big void in the therapy of PD lies in the more advanced stages. Several motor symptoms, like postural instability, dysphagia, and dysphonia, as well as dyskinesias, are poorly controlled by existing drugs. New therapies should also be developed against autonomic symptoms, particularly constipation.

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