scholarly journals Patterns of balance loss with systematic perturbations in Parkinson’s disease and multiple sclerosis

2021 ◽  
pp. 1-12
Author(s):  
Diane D. Allen ◽  
Jessica Gadayan ◽  
Rebecca Hughes ◽  
Christine Magdalin ◽  
Catherine Jang ◽  
...  
Keyword(s):  
Multiple Sclerosis ◽  
Parkinson’S Disease ◽  
Parkinson's Disease ◽  
Vulnerable Populations ◽  
Rating Scale ◽  
Reliable Assessment ◽  
Loss Of Balance ◽  
Healthy Control ◽  
Balance Loss ◽  
Anterior Posterior

BACKGROUND: Multiple sclerosis (MS) and Parkinson’s disease (PD) may affect balance differently. However, no studies have compared loss of balance (LOB) patterns following multi-directional perturbations. OBJECTIVE: 1) determine reliability of LOB ratings following standardized manual perturbations; 2) compare LOB ratings in MS, PD, and healthy control (HC) groups following perturbations at upper/lower torso, in anterior/posterior, right/left, and rotational directions. METHODS: 1) reviewers rated videotaped LOB following perturbations applied by 4 clinicians in 6–10 HCs. 2) three groups (64 MS, 42 PD and 32 HC) received perturbations. LOB ratings following perturbations were analyzed using two-factor mixed ANOVAs for magnitude and prevalence. RESULTS: 1) LOB ratings showed moderate to good ICC and good to excellent agreement. 2) MS group showed greater magnitude and prevalence of LOB than PD or HC groups (p <  .001). All groups showed greater LOB from right/left versus anterior/posterior perturbations (p <  .01). PD showed greater LOB from perturbations at upper versus lower torso; MS and HC showed greater LOB from posterior versus anterior perturbations. CONCLUSIONS: Our reliable rating scale showed differences in patterns of LOB following manual perturbations in MS, PD, and HC. Clinically accessible and reliable assessment of LOB could facilitate targeted perturbation-based interventions and reduce falls in vulnerable populations.

Stereopsis Deficits in Parkinson’s Disease and Their Clinical Implications

2020 ◽  
Author(s):  
Fang Ba ◽  
Tina T. Sang ◽  
Jaleh Fatehi ◽  
Wenjing He ◽  
Emanuel Mostofi ◽  
...  
Keyword(s):  
Parkinson’S Disease ◽  
Parkinson's Disease ◽  
Disease Severity ◽  
Rating Scale ◽  
Disease Status ◽  
Cognitive Status ◽  
Control Group ◽  
Motor Disorder ◽  
Healthy Control ◽  
Stereo Acuity

Abstract Background: Parkinson's disease (PD) is not exclusively a motor disorder. Among non-motor features, PD patients possess sensory visual dysfunctions. Stereopsis deficit can significantly impact patients' motor performance. However, it is not routinely tested, and its significance is under-investigated. Studying stereopsis using reliable 3D stimuli may help determine its implications in disease status in PD.The objective of the study is to investigate stereopsis abnormalities in PD with reliable and more physiological tools, and their correlation with indicators of PD severity. Methods: Twenty-four healthy control and 20 PD participants were first evaluated for visual acuity, visual field, contrast acuity, and stereoperception with 2D and Titmus stereotests, followed by the assessment with the 3D active shutter system. The correlation between stereopsis and disease severity, Unified Parkinson’s disease rating scale motor scores (UPDRS-III), levodopa equivalent daily dose (LEDD), course of disease and cognitive status were evaluated using univariate regression models. Results: Screening visual tests did not reveal any differences between PD and control group. With the 3D active shutter system, PD patients demonstrated significantly worse stereopsis (i.e p=0.002, 26 seconds of arc). There was a trend that UPDRS-III and LEDD negatively correlate with the stereo acuity, suggesting poorer stereoperception is related to disease severity. Preserved cognitive function correlated with more intact stereo acuity. Conclusion: With more reliable and physiological tools, PD patients exhibit poorer stereopsis. These deficits reflected PD motor and cognitive status. How stereopsis relates to gait, fall risks and navigation warrants more investigations in the future.

scholarly journals Laboratory versus daily life gait characteristics in patients with multiple sclerosis, Parkinson’s disease, and matched controls

2020 ◽  
Vol 17 (1) ◽  
Author(s):  
Vrutangkumar V. Shah ◽  
James McNames ◽  
Martina Mancini ◽  
Patricia Carlson-Kuhta ◽  
Rebecca I. Spain ◽  
...  
Keyword(s):  
Multiple Sclerosis ◽  
Parkinson’S Disease ◽  
Parkinson's Disease ◽  
Neurological Disease ◽  
Inertial Sensors ◽  
Daily Life ◽  
Area Under The Curve ◽  
Gait Characteristics ◽  
Discrete Moment ◽  
Healthy Control

Abstract Background and purpose  Recent findings suggest that a gait assessment at a discrete moment in a clinic or laboratory setting may not reflect functional, everyday mobility. As a step towards better understanding gait during daily life in neurological populations, we compared gait measures that best discriminated people with multiple sclerosis (MS) and people with Parkinson’s Disease (PD) from their respective, age-matched, healthy control subjects (MS-Ctl, PD-Ctl) in laboratory tests versus a week of daily life monitoring. Methods  We recruited 15 people with MS (age mean ± SD: 49 ± 10 years), 16 MS-Ctl (45 ± 11 years), 16 people with idiopathic PD (71 ± 5 years), and 15 PD-Ctl (69 ± 7 years). Subjects wore 3 inertial sensors (one each foot and lower back) in the laboratory followed by 7 days during daily life. Mann–Whitney U test and area under the curve (AUC) compared differences between PD and PD-Ctl, and between MS and MS-Ctl in the laboratory and in daily life. Results  Participants wore sensors for 60–68 h in daily life. Measures that best discriminated gait characteristics in people with MS and PD from their respective control groups were different between the laboratory gait test and a week of daily life. Specifically, the toe-off angle best discriminated MS versus MS-Ctl in the laboratory (AUC [95% CI] = 0.80 [0.63–0.96]) whereas gait speed in daily life (AUC = 0.84 [0.69–1.00]). In contrast, the lumbar coronal range of motion best discriminated PD versus PD-Ctl in the laboratory (AUC = 0.78 [0.59–0.96]) whereas foot-strike angle in daily life (AUC = 0.84 [0.70–0.98]). AUCs were larger in daily life compared to the laboratory. Conclusions Larger AUC for daily life gait measures compared to the laboratory gait measures suggest that daily life monitoring may be more sensitive to impairments from neurological disease, but each neurological disease may require different gait outcome measures.

Anticipatory Coarticulation in Multiple Sclerosis and Parkinson's Disease

2003 ◽  
Vol 46 (4) ◽  
pp. 990-1008 ◽  
Author(s):  
Kris Tjaden
Keyword(s):  
Multiple Sclerosis ◽  
Parkinson’S Disease ◽  
Parkinson's Disease ◽  
Speech Rate ◽  
Subtle Difference ◽  
Perceptual Contrast ◽  
Healthy Control ◽  
Perceptual Characteristics ◽  
Second Formant ◽  
First Moment

Research investigating coarticulatory patterns in dysarthria has the potential to provide insight regarding deficits in the organizational coherence of phonetic events that may underlie deviant perceptual characteristics. The current study investigated anticipatory coarticulation for 17 speakers with multiple sclerosis (MS), 12 speakers with Parkinson's disease (PD), and 29 healthy control speakers. V1-C-V2 sequences were used to investigate intersyllabic vowel to vowel effects (V2 to V1 effects), intersyllabic consonant to vowel effects (C to V1 effects), and intrasyllabic vowel to consonant effects (V2 to C effects). Second formant frequencies and first moment coefficients were used to infer coarticulation. In general, patterns of intersyllabic and intrasyllabic coarticulation were similar for speakers with MS, speakers with PD, and healthy control speakers. It therefore appears unlikely that coarticulatory patterns for speakers diagnosed with MS or PD strongly contribute to deviant perceptual characteristics, at least for the current group of speakers, most of whom were mildly to moderately impaired. Anticipatory vowel effects in /k/+vowel sequences, however, tended to be reduced for speakers with MS and speakers with PD when data for these 2 speaker groups were pooled and compared to control speakers. These results were not attributable to group differences in speech rate or articulatory scaling, defined as the extent of articulatory movements, and further suggest that coarticulatory deficits are not unique to particular neurological diagnoses or dysarthrias. Potential explanations for the /k/+vowel results include difficulties with anterior—posterior tongue positioning and the competing influences of minimizing articulatory effort and maintaining sufficient perceptual contrast. Despite this subtle difference in coarticulation between disordered speakers and healthy control speakers, the overall results suggest that anticipatory coarticulation for speakers with MS and speakers with PD is preserved.

scholarly journals Relating Anticipatory Postural Adjustments to Step Outcomes During Loss of Balance in People With Parkinson’s Disease

2018 ◽  
Vol 32 (10) ◽  
pp. 887-898 ◽  
Author(s):  
Daniel S. Peterson ◽  
Keith R. Lohse ◽  
Martina Mancini
Keyword(s):  
Parkinson’S Disease ◽  
Parkinson's Disease ◽  
Posterior Margin ◽  
Rating Scale ◽  
Anticipatory Postural Adjustments ◽  
Support Surface ◽  
Postural Adjustments ◽  
Margin Of Stability ◽  
Subsequent Step ◽  
Anterior Posterior

Background. Effective protective steps are critical for fall prevention, and anticipatory postural adjustments (APAs) after a perturbation but prior to protective steps affect step performance. Although APAs prior to protective steps are altered in people with Parkinson’s disease (PD), whether these changes affect subsequent step performance is poorly understood. Objective. Characterize the relationship between mediolateral APA size and protective step outcomes in response to anteroposterior balance perturbations in people with PD. Methods. Twenty-eight individuals with PD completed 25 forward and 25 backward protective steps in response to support surface translations. Multilevel linear models related mediolateral APA size to protective step outcomes. Results. During forward protective stepping, larger mediolateral APAs were associated with delayed ( P < .001) and larger ( P = .004) steps. Larger APAs were also associated with smaller mediolateral ( P < .001) but larger anterior-posterior center of mass movement at foot off ( P < .001). During backward stepping, larger APAs were associated with later steps ( P < .001) and smaller anterior-posterior margin of stability at first foot contact ( P < .001). During backward stepping, larger APAs were also associated with worse clinical (ie, UPDRS [Unified Parkinson’s Disease Rating Scale]; P = .005) and balance (ie, MiniBEST [Mini-Balance Evaluation Systems Test]; P = .021) outcomes. Conclusions. During forward protective stepping, larger APAs were associated with larger and later steps, suggesting APA size may have mixed effects on the subsequent step. During backward stepping, larger APAs were associated with worse stepping outcomes (ie, later steps, smaller anterior-posterior margin of stability, worse clinical outcomes). Interventions aimed at improving APAs in PD should monitor spatial and temporal protective step outcomes to ensure treatment does not negatively affect protective steps, particularly for forward stepping.

scholarly journals Hypernasality associated with basal ganglia dysfunction: evidence from Parkinson’s disease and Huntington’s disease

PeerJ ◽  
2016 ◽  
Vol 4 ◽  
pp. e2530 ◽  
Author(s):  
Michal Novotný ◽  
Jan Rusz ◽  
Roman Čmejla ◽  
Hana Růžičková ◽  
Jiří Klempíř ◽  
...  
Keyword(s):  
Parkinson’S Disease ◽  
Parkinson's Disease ◽  
Basal Ganglia ◽  
Huntington's Disease ◽  
Huntington’S Disease ◽  
Rating Scale ◽  
Acoustic Parameter ◽  
Perceptual Analysis ◽  
Healthy Control ◽  
Perceptual Assessment

BackgroundAlthough increased nasality can originate from basal ganglia dysfunction, data regarding hypernasality in Parkinson’s disease (PD) and Huntington’s disease (HD) are very sparse. The aim of the current study was to analyze acoustic and perceptual correlates of velopharyngeal seal closure in 37 PD and 37 HD participants in comparison to 37 healthy control speakers.MethodsAcoustical analysis was based on sustained phonation of the vowel /i/ and perceptual analysis was based on monologue. Perceptual analysis was performed by 10 raters using The Great Ormond Street Speech Assessment ’98. Acoustic parameters related to changes in a 1/3-octave band centered on 1 kHz were proposed to reflect nasality level and behavior through utterance.ResultsPerceptual analysis showed the occurrence of mild to moderate hypernasality in 65% of PD, 89% of HD and 22% of control speakers. Based on acoustic analyses, 27% of PD, 54% of HD and 19% of control speakers showed an increased occurrence of hypernasality. In addition, 78% of HD patients demonstrated a high occurrence of intermittent hypernasality. Further results indicated relationships between the acoustic parameter representing fluctuation of nasality and perceptual assessment (r= 0.51,p< 0.001) as well as the Unified Huntington Disease Rating Scale chorea composite subscore (r= 0.42,p= 0.01).ConclusionsIn conclusion the acoustic assessment showed that abnormal nasality was not a common feature of PD, whereas patients with HD manifested intermittent hypernasality associated with chorea.

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

scholarly journals Azathioprine immunosuppression and disease modification in Parkinson’s disease (AZA-PD): a randomised double-blind placebo-controlled phase II trial protocol

BMJ Open ◽  
2020 ◽  
Vol 10 (11) ◽  
pp. e040527
Author(s):  
Julia C Greenland ◽  
Emma Cutting ◽  
Sonakshi Kadyan ◽  
Simon Bond ◽  
Anita Chhabra ◽  
...  
Keyword(s):  
Parkinson’S Disease ◽  
Parkinson's Disease ◽  
Immune System ◽  
Phase Ii ◽  
Rating Scale ◽  
Positron Emission Tomography Imaging ◽  
Clinical Markers ◽  
Double Blind ◽  
Positron Emission ◽  
Immunosuppressant Medication

IntroductionThe immune system is implicated in the aetiology and progression of Parkinson’s disease (PD). Inflammation and immune activation occur both in the brain and in the periphery, and a proinflammatory cytokine profile is associated with more rapid clinical progression. Furthermore, the risk of developing PD is related to genetic variation in immune-related genes and reduced by the use of immunosuppressant medication. We are therefore conducting a ‘proof of concept’ trial of azathioprine, an immunosuppressant medication, to investigate whether suppressing the peripheral immune system has a disease-modifying effect in PD.Methods and analysisAZA-PD is a phase II randomised placebo-controlled double-blind trial in early PD. Sixty participants, with clinical markers indicating an elevated risk of disease progression and no inflammatory or immune comorbidity, will be treated (azathioprine:placebo, 1:1) for 12 months, with a further 6-month follow-up. The primary outcome is the change in the Movement Disorder Society-Unified Parkinson’s Disease Rating Scale gait/axial score in the OFF state over the 12-month treatment period. Exploratory outcomes include additional measures of motor and cognitive function, non-motor symptoms and quality of life. In addition, peripheral and central immune markers will be investigated through analysis of blood, cerebrospinal fluid and PK-11195 positron emission tomography imaging.Ethics and disseminationThe study was approved by the London-Westminster research ethics committee (reference 19/LO/1705) and has been accepted by the Medicines and Healthcare products Regulatory Agency (MHRA) for a clinical trials authorisation (reference CTA 12854/0248/001–0001). In addition, approval has been granted from the Administration of Radioactive Substances Advisory Committee. The results of this trial will be disseminated through publication in scientific journals and presentation at national and international conferences, and a lay summary will be available on our website.Trial registration numbersISRCTN14616801 and EudraCT- 2018-003089-14.

scholarly journals Glucocerebrosidase Activity is Reduced in Cryopreserved Parkinson’s Disease Patient Monocytes and Inversely Correlates with Motor Severity

2021 ◽  
pp. 1-9
Author(s):  
Laura P. Hughes ◽  
Marilia M.M. Pereira ◽  
Deborah A. Hammond ◽  
John B. Kwok ◽  
Glenda M. Halliday ◽  
...  
Keyword(s):  
Parkinson’S Disease ◽  
Parkinson's Disease ◽  
Peripheral Blood ◽  
Mononuclear Cells ◽  
Rating Scale ◽  
Disease Patient ◽  
Motor Symptom ◽  
Blood Monocytes ◽  
Peripheral Blood Monocytes ◽  
Classical Monocytes

Background: Reduced activity of lysosomal glucocerebrosidase is found in brain tissue from Parkinson’s disease patients. Glucocerebrosidase is also highly expressed in peripheral blood monocytes where its activity is decreased in Parkinson’s disease patients, even in the absence of GBA mutation. Objective: To measure glucocerebrosidase activity in cryopreserved peripheral blood monocytes from 30 Parkinson’s disease patients and 30 matched controls and identify any clinical correlation with disease severity. Methods: Flow cytometry was used to measure lysosomal glucocerebrosidase activity in total, classical, intermediate, and non-classical monocytes. All participants underwent neurological examination and motor severity was assessed by the Movement Disorders Society Unified Parkinson’s Disease Rating Scale. Results: Glucocerebrosidase activity was significantly reduced in the total and classical monocyte populations from the Parkinson’s disease patients compared to controls. GCase activity in classical monocytes was inversely correlated to motor symptom severity. Conclusion: Significant differences in monocyte glucocerebrosidase activity can be detected in Parkinson’s disease patients using cryopreserved mononuclear cells and monocyte GCase activity correlated with motor features of disease. Being able to use cryopreserved cells will facilitate the larger multi-site trials needed to validate monocyte GCase activity as a Parkinson’s disease biomarker.

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