Can People with Parkinson’s Disease Self-Trigger Gait Initiation? A Comparison of Cueing Strategies

2021 ◽  
pp. 1-13
Author(s):  
Matthew N. Petrucci ◽  
Sommer Amundsen Huffmaster ◽  
Jae Woo Chung ◽  
Elizabeth T. Hsiao-Wecksler ◽  
Colum D. MacKinnon
Keyword(s):  
Older Adults ◽  
Parkinson’S Disease ◽  
Parkinson's Disease ◽  
Young Adults ◽  
Older Adult ◽  
Freezing Of Gait ◽  
External Source ◽  
Anticipatory Postural Adjustments ◽  
Gait Initiation ◽  
Healthy Older Adults

Background: An external cue can markedly improve gait initiation in people with Parkinson’s disease (PD) and is often used to overcome freezing of gait (FOG). It is unknown if the effects of external cueing are comparable if the imperative stimulus is triggered by the person receiving the cue (self-triggered) or an external source. Objective: Two experiments were conducted to compare the effects of self- versus externally triggered cueing on anticipatory postural adjustments (APAs) during gait initiation in people with PD. Methods: In experiment 1, 10 individuals with PD and FOG initiated gait without a cue or in response to a stimulus triggered by the experimenter or by the participant. Experiment 2 compared self- versus externally triggered cueing across three groups: healthy young adults (n = 16), healthy older adults (n = 11), and a group with PD (n = 10). Results: Experiment 1: Externally triggered cues significantly increased APA magnitudes compared to uncued stepping, but not when the same cue was self-triggered. Experiment 2: APAs were not significantly improved with a self-triggered cue compared to un-cued stepping in both the PD and healthy older adult groups, but the young adults showed a significant facilitation of APA magnitude. Conclusion: The effectiveness of an external cue on gait initiation in people with PD and older adults is critically dependent upon whether the source of the trigger is endogenous (self-produced) or exogenous (externally generated). These results may explain why cueing interventions that rely upon self-triggering of the stimulus are often ineffective in people with PD.

scholarly journals Brain Activity Response to Visual Cues for Gait Impairment in Parkinson’s Disease: An EEG Study

2021 ◽  
pp. 154596832110413
Author(s):  
Samuel Stuart ◽  
Johanna Wagner ◽  
Scott Makeig ◽  
Martina Mancini
Keyword(s):  
Older Adults ◽  
Parkinson’S Disease ◽  
Parkinson's Disease ◽  
Visual Processing ◽  
Visual Cues ◽  
Brain Activity ◽  
Freezing Of Gait ◽  
Occipital Lobe ◽  
Brain Regions ◽  
Healthy Older Adults

Background. Gait impairments are common in Parkinson’s disease (PD) and increase falls risk. Visual cues can improve gait in PD, particularly freezing of gait (FOG), but mechanisms involved in visual cue response are unknown. This study aimed to examine brain activity in response to visual cues in people with PD who do (PD+FOG) and do not report FOG (PD-FOG) and explore relationships between attention, brain activity and gait. Methods. Mobile EEG measured brain activity during gait in 20 healthy older adults and 43 PD participants (n=22 PD+FOG, n=21 PD-FOG). Participants walked for 2-minutes with and without visual cues (transverse lines to step over). We report power spectral density (PSD) in Delta (1-4 Hz), Theta (4-7 Hz), Alpha (8-12 Hz), Beta (14-24 Hz) and Gamma (30-50 Hz) bands within clusters of similarly brain localized independent component sources. Results. PSDs within the parietal and occipital lobes were altered when walking with visual cues in PD, particularly in PD+FOG. Between group, differences suggested that parietal sources in PD, particularly with PD+FOG, had larger activity compared to healthy older adults when walking. Within group, visual cues altered brain activity in PD, particularly in PD+FOG, within visual processing brain regions. In PD participants, brain activity differences with cues correlated with gait improvements, and in PD+FOG those with worse attention required more visual attentional processing (reduced alpha PSD) in the occipital lobe. Conclusions. Visual cues improve gait and influence brain activity during walking in PD, particularly in PD+FOG. Findings may allow development of more effective therapeutics.

Possible selves and illness: A comparison of individuals with Parkinson's disease, early-stage Alzheimer's disease, and healthy older adults

2003 ◽  
Vol 27 (1) ◽  
pp. 1-11 ◽  
Author(s):  
Leslie D. Frazier ◽  
Victoria Cotrell ◽  
Karen Hooker
Keyword(s):  
Alzheimer’S Disease ◽  
Older Adults ◽  
Parkinson’S Disease ◽  
Alzheimer's Disease ◽  
Parkinson's Disease ◽  
Possible Selves ◽  
Early Stage ◽  
Healthy Older Adults ◽  
Patient Groups ◽  
The Impact

This study examined how future self-representations are affected by two different chronic illnesses, one focused on cognitive losses, early-stage Alzheimer's disease (AD), and one focused on physical losses, Parkinson's disease (PD). The impact of illness on possible selves (perceptions of self in the future) was made salient by a comparison with healthy older adults in order to better understand developmental issues in later life. Findings show that although there were no differences in the total number of domains reported by the groups, specific domains were reported differently by patient groups and all domains were likely to become infused with illness. As expected, patient groups had less self-efficacy and lower outcome expectancies for their future selves, and PD patients reported less distance from their feared selves. Although these findings are intuitive, this is the first empirical effort to document the impact of illness on older adults' self-representations. Group differences are explained in terms of disease context, and the importance of possible selves and self-regulatory functions as therapeutic mechanisms for adaptation to illness are emphasised.

scholarly journals Effects of Parkinson’s disease and dopamine on digit span measures of working memory

2018 ◽  
Author(s):  
John Patrick Grogan ◽  
Lisa Emily Knight ◽  
Laura Smith ◽  
Nerea Irigoras Izagirre ◽  
Alexandra Howat ◽  
...  
Keyword(s):  
Older Adults ◽  
Parkinson’S Disease ◽  
Working Memory ◽  
Parkinson's Disease ◽  
Digit Span ◽  
The Other ◽  
Healthy Older Adults ◽  
Memory Processes ◽  
Dopaminergic Medication ◽  
Conflicting Evidence

ABSTRACTRationaleParkinson’s disease (PD) impairs working memory (WM) - the ability to maintain items in memory for short periods of time and manipulate them. There is conflicting evidence on the nature of the deficits caused by the disease, and the potential beneficial and detrimental effects of dopaminergic medication on different WM processes.ObjectivesWe hypothesised that PD impairs both maintenance and manipulation of items in WM and dopaminergic medications improve this in PD patients but impair it in healthy older adults.MethodsWe tested 68 PD patients ON and OFF their dopaminergic medication, 83 healthy age-matched controls, and 30 healthy older adults after placebo and levodopa administration. We used the digit span, a WM test with three components (forwards, backwards and sequence recall) that differ in the amount of manipulation required. We analysed the maximum spans and the percentage of lists correctly recalled, which probe capacity of WM and the accuracy of the memory processes within this capacity, respectively.ResultsPD patients had lower WM capacity across all three digit span components, but only showed reduced percentage accuracy on the components requiring manipulation (backwards and sequence spans). Dopaminergic medication did not affect performance in PD patients. In healthy older adults, levodopa did not affect capacity, but did impair accuracy on one of the manipulation components (sequence), without affecting the other (backwards).ConclusionsThis suggests a non-dopaminergic deficit of maintenance capacity and manipulation accuracy in PD patients, and a potential “overdosing” of intact manipulation mechanisms in healthy older adults by levodopa.

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