scholarly journals Kinematic Metrics from a Wireless Stylus Quantify Tremor and Bradykinesia in Parkinson’s Disease

2019 ◽  
Vol 2019 ◽  
pp. 1-9
Author(s):  
Andres Maldonado-Naranjo ◽  
Mandy Miller Koop ◽  
Olivia Hogue ◽  
Jay Alberts ◽  
Andre Machado
Keyword(s):  
Parkinson’S Disease ◽  
Parkinson's Disease ◽  
New Technologies ◽  
Rating Scale ◽  
Clinical Care ◽  
Cleveland Clinic ◽  
Sensor Data ◽  
Objective Measures ◽  
Motor Deficits ◽  
Motion Sensor

A fundamental challenge in the clinical care of Parkinson disease (PD) is the current dependence on subjective evaluations of tremor and bradykinesia. New technologies offer the ability to evaluate motor deficits using purely objective measures. The aim of this study was to develop and evaluate the efficacy of a wireless stylus (Cleveland Clinic Stylus) with an embedded motion sensor to quantitatively assess tremor and bradykinesia in patients with PD with subthalamic nucleus (STN) deep brain stimulation (DBS). Twenty-one subjects were tested in various on and off DBS conditions while holding the Cleveland Clinic Stylus while at rest, maintaining a postural hold, and during a movement task. Kinematic metrics were calculated from the motion sensor data, including 3D angular velocity and 3D acceleration data, and were compared between the on and off conditions. Generalized estimating equations (GEEs) were used to determine the relationship between kinematic metrics and MDS-Unified Parkinson’s Disease Rating Scale Motor III (UPDRS-III) subscores. Kinematic metrics from the rest and postural tasks were significantly related to the UPDRS-III subscores of tremor (p<0.001 for all metrics), and kinematic metrics from the movement task were significantly related to the UPDRS-III subscore of bradykinesia (p<0.001 for 3/7 metrics). Kinematic metrics (7/9) showed a significant effect of stimulation setting (range: p<0.03–<0.0001) across the three tasks, indicating significant improvements from DBS in these measures. The Cleveland Clinic Stylus provided quantitative kinematic measures of tremor and bradykinesia severity and detected significant improvements in these measures from medication and DBS therapy. This low-cost, easy-to-use tool can provide objective measures that will improve clinical care of PD patients by providing a more reliable and objective evaluation of movement symptoms, disease progression, and effects of therapy in and outside the clinical setting.

scholarly journals The Add-On Effect of Lactobacillus plantarum PS128 in Patients With Parkinson's Disease: A Pilot Study

2021 ◽  
Vol 8 ◽  
Author(s):  
Chin-Song Lu ◽  
Hsiu-Chen Chang ◽  
Yi-Hsin Weng ◽  
Chiung-Chu Chen ◽  
Yi-Shan Kuo ◽  
...  
Keyword(s):  
Parkinson’S Disease ◽  
Parkinson's Disease ◽  
Lactobacillus Plantarum ◽  
Outcome Measures ◽  
Rating Scale ◽  
Controlled Trial ◽  
Secondary Outcome ◽  
Motor Deficits ◽  
Motor Symptoms ◽  
Non Motor Symptoms

Background:Lactobacillus plantarum PS128 (PS128) is a specific probiotic, known as a psychobiotic, which has been demonstrated to alleviate motor deficits and inhibit neurodegenerative processes in Parkinson's disease (PD)-model mice. We hypothesize that it may also be beneficial to patients with PD based on the possible mechanism via the microbiome-gut-brain axis.Methods: This is an open-label, single-arm, baseline-controlled trial. The eligible participants were scheduled to take 60 billion colony-forming units of PS128 once per night for 12 weeks. Clinical assessments were conducted using the Unified Parkinson's Disease Rating Scale (UPDRS), modified Hoehn and Yahr scale, and change in patient “ON-OFF” diary recording as primary outcome measures. The non-motor symptoms questionnaire, Beck depression inventory-II, patient assessment of constipation symptom, 39-item Parkinson's Disease Questionnaire (PDQ-39), and Patient Global Impression of Change (PGI-C) were assessed as secondary outcome measures.Results: Twenty-five eligible patients (32% women) completed the study. The mean age was 61.84 ± 5.74 years (range, 52–72), mean disease duration was 10.12 ± 2.3 years (range, 5–14), and levodopa equivalent daily dosage was 1063.4 ± 209.5 mg/daily (range, 675–1,560). All patients remained on the same dosage of anti-parkinsonian and other drugs throughout the study. After 12 weeks of PS128 supplementation, the UPDRS motor scores improved significantly in both the OFF and ON states (p = 0.004 and p = 0.007, respectively). In addition, PS128 intervention significantly improved the duration of the ON period and OFF period as well as PDQ-39 values. However, no obvious effect of PS128 on non-motor symptoms of patients with PD was observed. Notably, the PGI-C scores improved in 17 patients (68%). PS128 intervention was also found to significantly reduce plasma myeloperoxidase and urine creatinine levels.Conclusion: The present study demonstrated that PS128 supplementation for 12 weeks with constant anti-parkinsonian medication improved the UPDRS motor score and quality of life of PD patients. We suggest that PS128 could serve as a therapeutic adjuvant for the treatment of PD. In the future, placebo-controlled studies are needed to further support the efficacy of PS128 supplementation.Clinical Trial Registration:https://clinicaltrials.gov/, identifier: NCT04389762.

scholarly journals Stereopsis in Drug Naïve Parkinson's Disease Patients

2011 ◽  
Vol 38 (2) ◽  
pp. 299-302 ◽  
Author(s):  
Seung-Hyun Kim ◽  
Ji-Hye Park ◽  
Yu Hwan Kim ◽  
Seong-Beom Koh
Keyword(s):  
Parkinson’S Disease ◽  
Parkinson's Disease ◽  
Visual Perception ◽  
Rating Scale ◽  
De Novo ◽  
Motor Deficits ◽  
Disease Rating ◽  
Drug Naïve ◽  
The Relationship ◽  
Abnormal Visual

Background:Motor deficits associated with Parkinson's disease (PD) have been well described, yet little attention has been paid to non-motor symptoms, especially cortical visual dysfunction. We investigated stereopsis, as well as the relationship between stereopsis and other cognitive function, in a sample of PD patients.Methods:We used Titmus stereotest plates for assessing stereopsis. Fifty-nine subjects (29 PD patients and 30 normal controls) were included in this study. The included patients underwent a neurological examination, clinical rating scale and neuropsychological tests.Results:Drug naïve PD patients showed decreased stereopsis on the Titmus fly stereopsis test (Pearson χ2=23.80, p<0.001) compared to PD patients with normal stereopsis. The Hoehn-Yahr stages and Unified Parkinson's Disease Rating Scale motor scores were significantly higher in patients with PD with abnormal stereopsis than in patients with PD with normal stereopsis (p=0.026; p=0.046). The frequency of abnormal visual perception/constructive function was greater in patients with PD with abnormal stereopsis compared to patients with PD with normal stereopsis (Pearson χ2=5.11, p=0.024).Conclusion:These findings suggest that stereopsis deficits and visual perception/constructive dysfunction are common in de novo PD patients.

scholarly journals Atomoxetine and citalopram alter brain network organization in Parkinson’s disease

2019 ◽  
Vol 1 (1) ◽  
Author(s):  
Robin J Borchert ◽  
Timothy Rittman ◽  
Charlotte L Rae ◽  
Luca Passamonti ◽  
Simon P Jones ◽  
...  
Keyword(s):  
Parkinson’S Disease ◽  
Parkinson's Disease ◽  
Inhibitory Control ◽  
Reuptake Inhibitor ◽  
Rating Scale ◽  
Brain Network ◽  
Clustering Coefficient ◽  
Pharmacological Intervention ◽  
Motor Deficits ◽  
Network Organization

Abstract Parkinson’s disease has multiple detrimental effects on motor and cognitive systems in the brain. In contrast to motor deficits, cognitive impairments in Parkinson’s disease are usually not ameliorated, and can even be worsened, by dopaminergic treatments. Recent evidence has shown potential benefits from restoring other neurotransmitter deficits, including noradrenergic and serotonergic transmission. Here, we study global and regional brain network organization using task-free imaging (also known as resting-state), which minimizes performance confounds and the bias towards predetermined networks. Thirty-three patients with idiopathic Parkinson’s disease were studied three times in a double-blinded, placebo-controlled counter-balanced crossover design, following placebo, 40 mg oral atomoxetine (selective noradrenaline reuptake inhibitor) or 30 mg oral citalopram (selective serotonin reuptake inhibitor). Neuropsychological assessments were performed outside the scanner. Seventy-six controls were scanned without medication to provide normative data for comparison to the patient cohort. Graph theoretical analysis of task-free brain connectivity, with a random 500-node parcellation, was used to measure the effect of disease in placebo-treated state (versus unmedicated controls) and pharmacological intervention (drug versus placebo). Relative to controls, patients on placebo had executive impairments (reduced fluency and inhibitory control), which was reflected in dysfunctional network dynamics in terms of reduced clustering coefficient, hub degree and hub centrality. In patients, atomoxetine improved fluency in proportion to plasma concentration (P = 0.006, r2 = 0.24), and improved response inhibition in proportion to increased hub Eigen centrality (P = 0.044, r2 = 0.14). Citalopram did not improve fluency or inhibitory control, but its influence on network integration and efficiency depended on disease severity: clustering (P = 0.01, r2 = 0.22), modularity (P = 0.043, r2 = 0.14) and path length (P = 0.006, r2 = 0.25) increased in patients with milder forms of Parkinson’s disease, but decreased in patients with more advanced disease (Unified Parkinson’s Disease Rating Scale motor subscale part III &gt; 30). This study supports the use of task-free imaging of brain networks in translational pharmacology of neurodegenerative disorders. We propose that hub connectivity contributes to cognitive performance in Parkinson’s disease, and that noradrenergic treatment strategies can partially restore the neural systems supporting executive function.

scholarly journals Studies across subspecialties of neurology (SON) report noninferiority of telemedicine (TM) compared with face-to-face intervention (FTF-I)

2021 ◽  
Author(s):  
Paulo Eduardo Lahoz Fernandez ◽  
Guilherme Diogo Silva ◽  
Eduardo Genaro Mutarelli
Keyword(s):  
Parkinson’S Disease ◽  
Parkinson's Disease ◽  
Rating Scale ◽  
Short Form ◽  
Neurological Diseases ◽  
Clinical Care ◽  
Demyelinating Diseases ◽  
Symptom Scale ◽  
Vestibular Diseases ◽  
Face To Face

Background: Studies across subspecialties of neurology (SON) report noninferiority of telemedicine (TM) compared with face-to-face intervention (FTF-I). Clinical scales (CS) are important tools for outcome measures in clinical care. However, which CS in FTF-I can be used in teleneurology is unclear. Objectives: Define the most used CS in studies comparing TM with FTF-I in different SON. Design and Setting/Methods: We searched PubMed and Embase for randomized controlled trials, published from 2011 to April 2021, with Key words ‘’telemedicine’’ cross-referenced with ‘’neurology’’ or neurological diseases, considering the synonyms. Results: 43 eligible studies in 400 records, from 12 countries, with 5600 patients and 8 SON: stroke (10), headache (4), epilepsy (6), cognitive disorders (7), demyelinating diseases (8), movement disorders (3), neuromuscular diseases (3), and vestibular diseases (2). The most used CS: National Institute of Health Stroke Scale (NIHSS) and Modified Rankin Scale (MRS) for stroke impairment and limitation; Headache Impact Test (HIT-6) and Migraine Disability Assessment Scale (MIDAS) for headache disability; Quality Of Life in Epilepsy Inventory (QOL-31) for seizure burden; Mini-Mental State Exam (MMSE) and Zarit Burden Interview (ZBI) for cognitive function and caregiver burden in dementia care; Expanded Disability Status Scale (EDSS) and Fatigue Impact Scale (FIS) for disability and fatigue in Multiple Sclerosis; Parkinson’s disease Questionnaire (PDQ-39) and Unified Parkinson’s Disease Rating Scale (UPDRS) for QOL and disability in PD; Amyotrophic Lateral Sclerosis Functional Rating Scale Revised (ALSFRS-R) for severity in ALS; and Vertigo Symptom Scale Short form (VSS-SF) for vertigo. Conclusions: We present feasible CS usually applied in teleneurology that can be used as important tools for future findings in TM research and practice.

Glucocerebrosidase Mutations and Motor Reserve in Parkinson’s Disease

2021 ◽  
pp. 1-10
Author(s):  
Seok Jong Chung ◽  
Phil Hyu Lee ◽  
Young H. Sohn ◽  
Yun Joong Kim
Keyword(s):  
Parkinson’S Disease ◽  
Parkinson's Disease ◽  
Rating Scale ◽  
Motor Deficits ◽  
Dopamine Depletion ◽  
Affected Side ◽  
Disease Rating ◽  
Individual Capacity ◽  
The Individual ◽  
Gba Mutations

Background: The concept of motor reserve explains the individual differences in motor deficits despite similar degrees of nigrostriatal dopamine depletion in Parkinson’s disease (PD). Objective: To investigate glucocerebrosidase (GBA) variants as potential determinants of motor reserve for exploratory purposes. Methods: A total of 408 patients with drug-naïve PD were enrolled from the Parkinson’s Progression Markers Initiative cohort database. All patients underwent SPECT dopamine transporter (DAT) scans and had results for Sanger sequencing of GBA. Parkinsonian motor deficits were assessed using the Movement Disorders Society Unified Parkinson’s Disease Rating Scale Part III (MDS-UPDRS-III). We compared MDS-UPDRS-III scores while adjusting for DAT availability in the putamen (i.e., motor reserve) between the PD groups according to the presence of GBA mutations. Results: Fifty-four (13.2%) patients carried GBA mutations. PD patients with GBA mutations were younger than those without mutations. There were no significant differences in sex, disease duration, years of education, and striatal DAT availability between the PD groups. PD patients with GBA mutations had higher MDS-UPDRS-III scores for the less affected side than those without mutations, despite similar levels of DAT availability in the contralateral putamen. The MDS-UPDRS-III sub-scores of the more affected side did not differ between the two PD groups. Conclusion: The results of this study demonstrated the detrimental effect of GBA variants on individual capacity to cope with PD-related pathologies, with different impacts depending on the motor laterality.

scholarly journals Cognitive and Motor Correlates of Grey and White Matter Pathology in Parkinson’s Disease

2020 ◽  
Author(s):  
Mahsa Dadar ◽  
Myrlene Gee ◽  
Ashfaq Shuaib ◽  
Simon Duchesne ◽  
Richard Camicioli
Keyword(s):  
Parkinson’S Disease ◽  
Parkinson's Disease ◽  
White Matter ◽  
Substantia Nigra ◽  
Cognitive Deficits ◽  
Grey Matter ◽  
Rating Scale ◽  
Motor Deficits ◽  
Mri Features ◽  
Grey Matter Atrophy

AbstractIntroductionPrevious studies have found associations between grey matter atrophy and white matter hyperintensities (WMH) of vascular origin with cognitive and motor deficits in Parkinson’s disease (PD). Here we investigate these relationships in a sample of PD patients and age-matched healthy controls.MethodsData included 50 PD patients and 45 age-matched controls with T1-weighted and FLAIR scans at baseline, 18-months, and 36-months follow-up. Deformation-based morphometry was used to measure grey matter atrophy. SNIPE (Scoring by Nonlocal Image Patch Estimator) was used to measure Alzheimer’s disease-like textural patterns in the hippocampi. WMHs were segmented using T1-weighted and FLAIR images. The relationship between MRI features and clinical scores was assessed using mixed-effects models. The motor subscore of the Unified Parkinson’s Disease Rating Scale (UPDRSIII), number of steps in a walking trial, and Dementia Rating Scale (DRS) were used respectively as measures of motor function, gait, and cognition.ResultsSubstantia nigra atrophy was significantly associated with motor deficits, with a greater impact in PDs (p<0.05). Hippocampal SNIPE scores were associated with cognitve decline in both PD and controls (p<0.01). WMH burden was significantly associated with cognitive decline and increased motor deficits in the PD group, and gait deficits in both PD and controls (p<0.03).ConclusionWhile substantia nigra atrophy and WMH burden were significantly associated with additional motor deficits, WMH burden and hippocampal atrophy were associated with cognitive deficits in PD patients. These results suggest an additive contribution of both grey and white matter damage to the motor and cognitive deficits in PD.

Parkinson's Disease Cognitive Functional Rating Scale

2012 ◽  
Author(s):  
Jaime Kulisevsky ◽  
Ramón Fernández de Bobadilla ◽  
Javier Pagonabarraga
Keyword(s):  
Parkinson’S Disease ◽  
Parkinson's Disease ◽  
Rating Scale

Association of the Non-Motor Burden with Patterns of Striatal Dopamine Loss in de novo Parkinson’s Disease

2020 ◽  
Vol 10 (4) ◽  
pp. 1541-1549
Author(s):  
Seok Jong Chung ◽  
Sangwon Lee ◽  
Han Soo Yoo ◽  
Yang Hyun Lee ◽  
Hye Sun Lee ◽  
...  
Keyword(s):  
Parkinson’S Disease ◽  
Parkinson's Disease ◽  
De Novo ◽  
Early Stage ◽  
Striatal Dopamine ◽  
Motor Deficits ◽  
Dopamine Depletion ◽  
Severe Motor ◽  
Severe Group ◽  
Striatal Dopamine Depletion

Background: Striatal dopamine deficits play a key role in the pathogenesis of Parkinson’s disease (PD), and several non-motor symptoms (NMSs) have a dopaminergic component. Objective: To investigate the association between early NMS burden and the patterns of striatal dopamine depletion in patients with de novo PD. Methods: We consecutively recruited 255 patients with drug-naïve early-stage PD who underwent 18F-FP-CIT PET scans. The NMS burden of each patient was assessed using the NMS Questionnaire (NMSQuest), and patients were divided into the mild NMS burden (PDNMS-mild) (NMSQuest score <6; n = 91) and severe NMS burden groups (PDNMS-severe) (NMSQuest score >9; n = 90). We compared the striatal dopamine transporter (DAT) activity between the groups. Results: Patients in the PDNMS-severe group had more severe parkinsonian motor signs than those in the PDNMS-mild group, despite comparable DAT activity in the posterior putamen. DAT activity was more severely depleted in the PDNMS-severe group in the caudate and anterior putamen compared to that in the PDMNS-mild group. The inter-sub-regional ratio of the associative/limbic striatum to the sensorimotor striatum was lower in the PDNMS-severe group, although this value itself lacked fair accuracy for distinguishing between the patients with different NMS burdens. Conclusion: This study demonstrated that PD patients with severe NMS burden exhibited severe motor deficits and relatively diffuse dopamine depletion throughout the striatum. These findings suggest that the level of NMS burden could be associated with distinct patterns of striatal dopamine depletion, which could possibly indicate the overall pathological burden in PD.

Sign in / Sign up

Export Citation Format

Share Document