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.

scholarly journals Central Pain in Parkinson’s Disease: Behavioral and Cognitive Characteristics

2021 ◽  
Vol 2021 ◽  
pp. 1-7
Author(s):  
N. Vila-Chã ◽  
S. Cavaco ◽  
A. Mendes ◽  
A. Gonçalves ◽  
I. Moreira ◽  
...  
Keyword(s):  
Parkinson’S Disease ◽  
Parkinson's Disease ◽  
Cognitive Performance ◽  
Rating Scale ◽  
Short Form ◽  
Structured Interview ◽  
Smoking Habits ◽  
Addictive Behaviors ◽  
Study Results ◽  
Compulsive Behaviors

Introduction. Pain is a major nonmotor symptom of Parkinson’s disease (PD), and central parkinsonian pain is the core feature of the putative Park pain subtype of PD. This study aimed to explore the cognitive and behavioral profile of PD patients with central parkinsonian pain. Material and Methods. A structured interview was used to identify and characterize pain in a cohort of 260 consecutive PD patients. The Ford classification of pain was applied. The Dementia Rating Scale-2 (DRS-2) and the Impulse Control Disorders in Parkinson’s Disease Short Form (QUIP-S) were administered, and patients’ smoking habits were recorded. The Unified Parkinson’s Disease Rating Scale (UPDRS) was used to assess motor and nonmotor symptoms in off and on conditions. Results. One hundred and eighty-eight patients (68%) reported pain; and in 41 (22%) of them, the pain was classified as central parkinsonian pain. PD patients with central parkinsonian pain had better cognitive performance in DRS-2 Initiation/Perseveration and Conceptualization subscales but reported more other compulsive behaviors (e.g., hobbyism, punding, and walkabout) and had more current smoking habits than those without pain or with non-central parkinsonian pain. Multiple logistic regression analyses revealed that the DRS-2 Conceptualization subscale, other compulsive behaviors, and smoking habits remained statistically associated with central parkinsonian pain even when other significant covariates were considered. Only patients with pain, regardless of type, had a gambling disorder. Discussion. The study results provide further evidence that pain revealed that patients with central parkinsonian pain are more likely to present compulsive or addictive behaviors, despite having more preserved cognitive performance. Patients with central parkinsonian pain appear to have a distinct phenotype of PD.

Pelvic Floor Health in Women with Parkinson’s Disease

2021 ◽  
Vol 11 (2) ◽  
pp. 857-864 ◽  
Author(s):  
Ankita Gupta ◽  
Kathrin LaFaver ◽  
Kevin R. Duque ◽  
Anushree Lingaiah ◽  
Kate V. Meriwether ◽  
...  
Keyword(s):  
Parkinson’S Disease ◽  
Parkinson's Disease ◽  
Pelvic Floor ◽  
Rating Scale ◽  
Short Form ◽  
Pelvic Floor Dysfunction ◽  
Measurement Information ◽  
Cognitive Score ◽  
Patient Reported ◽  
The Difference

Background: Urinary dysfunction and constipation, manifestations of pelvic floor dysfunction are common sources of disability and impaired quality of life in women with Parkinson’s disease (PD). Objective: We sought to evaluate the pelvic floor health amongst women with PD and their reporting of bladder and bowel symptoms. Methods: We surveyed women with PD and age-matched controls about pelvic floor health using validated questionnaires. All participants completed the Pelvic Floor Disability Index (PFDI-20), the Pelvic Floor Impact Questionnaire (PFIQ-7) and the Patient-Reported Outcomes Measurement Information System (PROMIS) short form version 2.0 Cognitive Function 8a. Additionally, PD patients underwent the Movement Disorders Society Unified Parkinson’s Disease Rating Scale (MDS-UPDRS) scale and the Montreal Cognition Assessment (MoCA). Results: Women with PD (n = 59; age, 70.4±8.6 years, PROMIS cognitive score, 52.0±7.8) self-reported urinary symptoms to a greater extent than controls (n = 59; age, 70.2±8.7 years, PROMIS cognitive score, 51.0±10) (68% vs 43%, p < 0.01). The difference was mirrored by higher (worse) scores on both PFDI-20 (35.4 vs 15.6; p = 0.01) and PFIQ-7 (4.8 vs 0; p < 0.01) for PD women compared to controls. Only 63% of all participants with self-reported pelvic floor symptoms had previously reported these symptoms to a health care provider. There was no difference in utilization of specialty care between the two groups (30% vs 46%, p = 0.2). Conclusion: Pelvic floor dysfunction, more common amongst women with PD, is underreported and undertreated. Our study identifies a key gap in care of women with PD.

scholarly journals Determinants of self-efficacy in patients with Parkinson’s disease

2021 ◽  
Vol 79 (8) ◽  
pp. 686-691
Author(s):  
Ingrid Estrada-Bellmann ◽  
Jesús Daniel Meléndez-Flores ◽  
Carlos Rodrigo Cámara-Lemarroy ◽  
Sergio Andrés Castillo-Torres
Keyword(s):  
Quality Of Life ◽  
Parkinson’S Disease ◽  
Parkinson's Disease ◽  
Self Efficacy ◽  
Rating Scale ◽  
Motor Symptom ◽  
Life Questionnaire ◽  
Symptom Scale ◽  
Cross Sectional

ABSTRACT Background: Self-efficacy is the individual’s assessment of his or hers ability to complete a specific task successfully and has been closely related to self-management and quality of life in several diseases. Objective: To investigate self-efficacy in a population of Parkinson’s disease (PD) patients in Mexico and study the factors that are associated with this measure. Methods: We carried out a cross-sectional observational study involving patients with PD in an outpatient neurology clinic in Mexico, using the following instruments: Spanish version of the Chronic Disease Self-Efficacy Scale (CDSES), Quality of Life Questionnaire PDQ-8, Movement Disorders Society-Unified Parkinson's disease Rating Scale (MDS-UPDRS), Montreal Cognitive Assessment (MoCA), and Non-Motor Symptom Scale (NMSS). Clinical and demographic variables were also recorded. Results: We included 73 patients with a mean age of 65 years and most patients were male. Patients with lower CDSES scores (<7.75) had worse scores in MDS-UPDRS, NMSS, and PDQ-8 scales. CDSES scores were significantly correlated with MDS-UPDRS Part I (r=-0.497, p=<0.001), Part II (r= -0.271, p=0.020), Part III (r=-0.304, p=<0.001), PDQ-8 (r=-0.472, p=<0.001), and NMSS (r=-0.504, p=<0.001). Furthermore, when assessing the simultaneous effect of covariates associated with CDSES score, only Mood/Apathy domain of NMSS was significant (beta= -0.446, t= -3.807, p= 0.012). Conclusions: PD patients with lower self-efficacy scores had worse motor and non-motor symptomatology and quality of life. Mood/Apathy disorders were negatively associated with self-efficacy and contributed significantly to this measure.

scholarly journals A Clinically Interpretable Computer-Vision Based Method for Quantifying Gait in Parkinson’s Disease

Sensors ◽  
2021 ◽  
Vol 21 (16) ◽  
pp. 5437
Author(s):  
Samuel Rupprechter ◽  
Gareth Morinan ◽  
Yuwei Peng ◽  
Thomas Foltynie ◽  
Krista Sibley ◽  
...  
Keyword(s):  
Parkinson’S Disease ◽  
Computer Vision ◽  
Parkinson's Disease ◽  
Bayesian Model ◽  
Rating Scale ◽  
Neurological Diseases ◽  
Classification Model ◽  
Step Frequency ◽  
Gait Impairment ◽  
Severity Rating

Gait is a core motor function and is impaired in numerous neurological diseases, including Parkinson’s disease (PD). Treatment changes in PD are frequently driven by gait assessments in the clinic, commonly rated as part of the Movement Disorder Society (MDS) Unified PD Rating Scale (UPDRS) assessment (item 3.10). We proposed and evaluated a novel approach for estimating severity of gait impairment in Parkinson’s disease using a computer vision-based methodology. The system we developed can be used to obtain an estimate for a rating to catch potential errors, or to gain an initial rating in the absence of a trained clinician—for example, during remote home assessments. Videos (n=729) were collected as part of routine MDS-UPDRS gait assessments of Parkinson’s patients, and a deep learning library was used to extract body key-point coordinates for each frame. Data were recorded at five clinical sites using commercially available mobile phones or tablets, and had an associated severity rating from a trained clinician. Six features were calculated from time-series signals of the extracted key-points. These features characterized key aspects of the movement including speed (step frequency, estimated using a novel Gamma-Poisson Bayesian model), arm swing, postural control and smoothness (or roughness) of movement. An ordinal random forest classification model (with one class for each of the possible ratings) was trained and evaluated using 10-fold cross validation. Step frequency point estimates from the Bayesian model were highly correlated with manually labelled step frequencies of 606 video clips showing patients walking towards or away from the camera (Pearson’s r=0.80, p<0.001). Our classifier achieved a balanced accuracy of 50% (chance = 25%). Estimated UPDRS ratings were within one of the clinicians’ ratings in 95% of cases. There was a significant correlation between clinician labels and model estimates (Spearman’s ρ=0.52, p<0.001). We show how the interpretability of the feature values could be used by clinicians to support their decision-making and provide insight into the model’s objective UPDRS rating estimation. The severity of gait impairment in Parkinson’s disease can be estimated using a single patient video, recorded using a consumer mobile device and within standard clinical settings; i.e., videos were recorded in various hospital hallways and offices rather than gait laboratories. This approach can support clinicians during routine assessments by providing an objective rating (or second opinion), and has the potential to be used for remote home assessments, which would allow for more frequent monitoring.

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 An Integrated Multi-Sensor Approach for the Remote Monitoring of Parkinson’s Disease

Sensors ◽  
2019 ◽  
Vol 19 (21) ◽  
pp. 4764 ◽  
Author(s):  
Giovanni Albani ◽  
Claudia Ferraris ◽  
Roberto Nerino ◽  
Antonio Chimienti ◽  
Giuseppe Pettiti ◽  
...  
Keyword(s):  
Parkinson’S Disease ◽  
Parkinson's Disease ◽  
Remote Monitoring ◽  
Rating Scale ◽  
Population Aging ◽  
Neurological Diseases ◽  
Low Cost ◽  
Wearable Sensors ◽  
Cost Effective ◽  
The Body

The increment of the prevalence of neurological diseases due to the trend in population aging demands for new strategies in disease management. In Parkinson’s disease (PD), these strategies should aim at improving diagnosis accuracy and frequency of the clinical follow-up by means of decentralized cost-effective solutions. In this context, a system suitable for the remote monitoring of PD subjects is presented. It consists of the integration of two approaches investigated in our previous works, each one appropriate for the movement analysis of specific parts of the body: low-cost optical devices for the upper limbs and wearable sensors for the lower ones. The system performs the automated assessments of six motor tasks of the unified Parkinson’s disease rating scale, and it is equipped with a gesture-based human machine interface designed to facilitate the user interaction and the system management. The usability of the system has been evaluated by means of standard questionnaires, and the accuracy of the automated assessment has been verified experimentally. The results demonstrate that the proposed solution represents a substantial improvement in PD assessment respect to the former two approaches treated separately, and a new example of an accurate, feasible and cost-effective mean for the decentralized management of PD.

scholarly journals Validation of the Parkinson’s Disease Caregiver Burden Questionnaire in Progressive Supranuclear Palsy

2021 ◽  
Vol 2021 ◽  
pp. 1-7
Author(s):  
Martin Klietz ◽  
Hannah V. Eichel ◽  
Selma Staege ◽  
Anna Kutschenko ◽  
Gesine Respondek ◽  
...  
Keyword(s):  
Parkinson’S Disease ◽  
Parkinson's Disease ◽  
Progressive Supranuclear Palsy ◽  
Caregiver Burden ◽  
Rating Scale ◽  
Longitudinal Design ◽  
Short Form ◽  
Depression Scale ◽  
Life Questionnaire ◽  
Internal Reliability

Progressive supranuclear palsy (PSP) is an atypical Parkinson syndrome with axial akinetic-rigid symptoms, early postural instability, and ocular motor impairments. Patients experience a rapid loss of autonomy and care dependency; thus, caregivers must assist in the activities of daily living early in the course of the disease. Caregiver burden is an extremely important factor in disease management. However, there are no specific questionnaires for assessment of caregiver burden in PSP. This study aims to validate the Parkinson’s disease caregiver burden questionnaire (PDCB) as a specific measure of caregiver burden in PSP. PSP patients were assessed by the PSP rating scale, PSP quality-of-life questionnaire (PSP-QoL), Montreal cognitive assessment test (MoCA), and geriatric depression scale (GDS-15). Caregivers filled out the short form 36-health survey, GDS-15, PDCB, and the caregiver burden inventory (CBI). 22 patient caregiver pairs completed the study. PDCB showed a highly significant correlation with the CBI (r 0.911; p < 0.001 ). Internal reliability of the PDCB measured by Cronbach’s alpha was favourable at 0.803. These data support the specificity of the PDCB in PSP caregivers. Future studies with larger sample sizes of PSP patients and caregivers and a multicentric longitudinal design should be performed to gain further insight of caregiver burden in PSP.

scholarly journals The Methods of Detection of Gait Disturbance and Postural Instability in Case of Parkinson’s Disease

2018 ◽  
Vol 3 (2) ◽  
pp. 37-40
Author(s):  
IE E Poverennova ◽  
VA A Kalinin ◽  
SA A Shpileva
Keyword(s):  
Parkinson’S Disease ◽  
Parkinson's Disease ◽  
Rating Scales ◽  
Rating Scale ◽  
Neurological Diseases ◽  
Freezing Of Gait ◽  
Postural Instability ◽  
Motor Disorders ◽  
Medication Therapy ◽  
Disease Rating

Parkinson’s disease takes first place among neurological diseases of senior persons and its prevalence consists of 2% among people elderly than 65 years old. Disturbance of gait and postural instability are the most important motor disorders in case of Parkinson’s disease. Aim - to reveal factors which influence on the falling down of patients with Parkinson’s disease. Materials and methods. The use of unified Parkinson’s disease rating scale for examination of patients with Parkinson’s disease was performed. Results of rating scales were analyzed due to regression analysis. Results. It was revealed that the most important factor of falling down is the disturbance of gait. Freezing of gait has little influence on falling. Conclusion. The use of such diagnostic tests in the routine neurological examination allows to optimize medication therapy and to use modern non- medication methods of correction of gait.

scholarly journals The Effect of Conduction Exercise and Self-Acupressure in Treatment of Parkinson’s Disease: A Pilot Study

2020 ◽  
Vol 2020 ◽  
pp. 1-9
Author(s):  
Chun-Sum Yuen ◽  
Ka-Kit Chua ◽  
Wai-Hing Lau ◽  
Zhi-Yuen Zhuang ◽  
Ho-Yan Chow ◽  
...  
Keyword(s):  
Parkinson’S Disease ◽  
Parkinson's Disease ◽  
Treatment Group ◽  
Short Form ◽  
Complementary Therapy ◽  
Control Group ◽  
Clinical Trial Registry ◽  
Symptom Scale ◽  
Secondary Outcomes ◽  
Domain Scores

Introduction. Parkinson’s disease cannot be well treated by conventional medication. Acupuncture and Tai Chi are proven to be effective in relieving symptoms of Parkinson’s disease. Traditional Chinese medicine exercises may prove to be an effective complementary therapy. Objective. To evaluate the efficacy and safety of conduction exercise and self-acupressure in treating Parkinson’s disease. Method. This study is an accessor- and data analyzer-blind, add-on, randomized, controlled, pilot clinical study. In the treatment group, they were taught to practice conduction exercise and self-acupressure for 8 weeks. No additional treatment was given in the control group. Assessments were done at week 4 and week 8 of the treatment period. The primary outcomes are the total score and domain scores of the Chinese version of 39-item Parkinson’s Disease Questionnaire. The secondary outcomes are the total score and domain scores of a custom-designed questionnaire, which is a short form of Nonmotor Symptom Scale. Results. 22 patients in the treatment group and 14 in the control group continued to the treatment phase. Patients in the treatment group displayed improvement trends in primary and secondary outcomes. Improvements were significant in two areas of a custom-designed questionnaire: total score (p=0.014) and domain score of gastrointestinal tract (p=0.004). No severe adverse events were reported. Conclusion. Conduction exercise and self-acupressure were well accepted by and feasible for Parkinson’s disease patients. The data generated can be used for the planning of future studies. The exercise regime can be promoted as a home-based, self-practice therapy for Parkinson’s disease patients, due to its safety, low cost, and convenience in implementation. This study is registered with the Chinese Clinical Trial Registry (ChiCTR-IPR-17011987, on 14 July 2017).

scholarly journals Depression and other nonmotor manifestations of Parkinson’s disease

2017 ◽  
Vol 95 (5) ◽  
pp. 419-424
Author(s):  
I. A. Zhukova ◽  
N. G. Zhukova ◽  
V. M. Alifirova ◽  
M. A. Nikitina ◽  
O. P. Izhboldina ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Parkinson’S Disease ◽  
Parkinson's Disease ◽  
Rating Scale ◽  
Short Form ◽  
Depression Scale ◽  
Severe Depression ◽  
Well Being ◽  
Life Questionnaire

Background. The occurrence of emotional, cognitive, behavioral disorders associated with Parkinson’s disease is on the average 1.5-3 times higher than in the general population of the same age. At least one neuropsychiatric symptom is diagnosed in 77% of the patients and 46% have combination of three or more disturbances. Non-motor disturbances are manifested at all stages of Parkinson’s disease, but information about the relationship between their frequency and manifestations and the duration and severity of the disease is rather contradictory. Aim. To evaluate the prevalence and severity of depression and other non-motor symptoms in patients with Parkinson’s disease. Materials and methods. 206 patients at the average age 65.9±9.7 yr with Parkinson’s disease receiving pharmacotherapy were studied. The clinical assessment was carried out using the Unified Parkinson’s Disease Rating Scale, Hoehn & Yahr Scale, Beck depression inventory II, Hospital anxiety and depression scale, Apathy Scale, Questionnaire for Impulsive-Compulsive Disorders in PD-Rating Scale, Montreal Cognitive Assessment, Parkinson’s Disease Quality of Life Questionnaire- 39, Medical Outcomes Study 36-Item Short Form. Results. 30.9% of the 62 patients with Parkinson’s disease suffered mild, 56 (27.4%) moderate, 21 (10.2%) severe depression and only 67 (32.5%) patients had no depression. The study revealed correlation of depression with apathy (r=0,488; p<0,001), low quality of life according to the PDQ-39 (r=0,471; p<0,001), cognition (r=0,451; p<0,001), emotional well-being (r=0,450; p≤0,001), anxiety (r=0,436; p<0,001). Conclusion. The prevalence of depression in patients with Parkinson’s disease is up to 67.5%. The proportion of patients with severe depression reaches 10.2%. Depression is one of the most frequent non-motor syndromes of Parkinson’s disease deteriorating the quality of life of the patients.

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