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Neurologia Sep 2021Reliable assessment of individuals with Parkinson's disease (PD) is essential for providing adequate treatment. Clinical assessment is a complex and time-consuming task,...
INTRODUCTION
Reliable assessment of individuals with Parkinson's disease (PD) is essential for providing adequate treatment. Clinical assessment is a complex and time-consuming task, especially for bradykinesia, since its evaluation can be influenced by the degree of experience of the examiner, patient collaboration and individual bias. Improvement of the clinical evaluation can be obtained by considering assessments from several professionals. However, this is only true when inter and intra-rater agreement are high. Recently, the Movement Disorder Society highlighted, during the COVID-19 pandemic, the need to develop and validate technologies for remote assessment of the motor status of people with PD. Thus, this study introduces an objective strategy for the remote evaluation of bradykinesia using multi-specialist analysis.
METHODS
Twelve volunteers with PD participated and these were asked to execute finger tapping, hand opening/closing and pronation/supination movements. Each task was recorded and rated by fourteen PD health experts for each patient. The scores were assessed on an individual basis. Intra and inter-rater agreement and correlation were estimated.
RESULTS
The results showed that agreements and correlations between experienced examiners were high with low variability. In addition, group analysis was noted as possessing the potential to solve individual inconsistency bias.
CONCLUSION
Furthermore, this study demonstrated the need for a group with prior training and experience, along with indicating the importance for the development of a clinical protocol that can use telemedicine for the evaluation of individuals with PD, as well as the inclusion of a specialized mediating group. In Addition, this research helps to the development of a valid remote assessment of bradykinesia.
PubMed: 34538673
DOI: 10.1016/j.nrl.2021.08.005 -
The Journal of Clinical Psychiatry Jan 2023Patients who require antipsychotic drug treatment are at increased risk of fractures, including osteoporosis-related fragility fractures, for reasons related to... (Meta-Analysis)
Meta-Analysis
Patients who require antipsychotic drug treatment are at increased risk of fractures, including osteoporosis-related fragility fractures, for reasons related to demographics, illness-related factors, and treatment-related factors. As examples, patients with dementia may be vulnerable to falls due to cognitive and psychomotor impairment, patients with schizophrenia may be vulnerable to injury related to physical restlessness or physical aggression, and patients receiving antipsychotics may suffer falls related to sedation, psychomotor impairment, bradykinesia, or postural hypotension. Antipsychotics may also increase the risk of fracture through long-term hyperprolactinemia and resultant osteoporosis. A meta-analysis of 36 observational studies conducted in mostly elderly samples found that antipsychotic exposure was associated with an increased risk of hip fracture as well as increased risk of any fracture; the findings were consistent in almost all subgroup analyses. An observational study that controlled for confounding by indication and illness severity found that fragility fractures in patients with schizophrenia were associated with higher daily doses, higher cumulative doses, longer duration of treatment, and prolactin-raising rather than prolactin-sparing antipsychotics; in patients receiving prolactin-raising antipsychotics, the concurrent use of aripiprazole appeared protective. The absolute risks of fracture are unknown and could vary depending on patient age, patient sex, indication for antipsychotic use, nature of the antipsychotic (and associated risk of sedation, psychomotor impairment, bradykinesia, and postural hypotension), daily dose prescribed, duration of antipsychotic exposure, baseline risk of fracture, and other risk factors. Patients should therefore be individually evaluated for risk factors for falls and fractures related to sociodemographic, clinical, and treatment-related risk factors. Patients identified to be at risk should be advised about risk-mitigating strategies. If prolactin-raising antipsychotics are required in the long term, prolactin levels should be monitored and prolactin-lowering strategies should be considered. Osteoporosis should be investigated and managed, if identified, to prevent fragility fractures.
Topics: Humans; Aged; Antipsychotic Agents; Prolactin; Schizophrenia; Hypokinesia; Hypotension, Orthostatic; Hyperprolactinemia; Osteoporosis; Risk Factors; Dementia; Observational Studies as Topic
PubMed: 36724110
DOI: 10.4088/JCP.23f14790 -
Sensors (Basel, Switzerland) Feb 2021Parkinson's disease patients face numerous motor symptoms that eventually make their life different from those of normal healthy controls. Out of these motor symptoms,...
Parkinson's disease patients face numerous motor symptoms that eventually make their life different from those of normal healthy controls. Out of these motor symptoms, tremor and bradykinesia, are relatively prevalent in all stages of this disease. The assessment of these symptoms is usually performed by traditional methods where the accuracy of results is still an open question. This research proposed a solution for an objective assessment of tremor and bradykinesia in subjects with PD (10 older adults aged greater than 60 years with tremor and 10 older adults aged greater than 60 years with bradykinesia) and 20 healthy older adults aged greater than 60 years. Physical movements were recorded by means of an AWEAR bracelet developed using inertial sensors, i.e., 3D accelerometer and gyroscope. Participants performed upper extremities motor activities as adopted by neurologists during the clinical assessment based on Unified Parkinson's Disease Rating Scale (UPDRS). For discriminating the patients from healthy controls, temporal and spectral features were extracted, out of which non-linear temporal and spectral features show greater difference. Both supervised and unsupervised machine learning classifiers provide good results. Out of 40 individuals, neural net clustering discriminated 34 individuals in correct classes, while the KNN approach discriminated 91.7% accurately. In a clinical environment, the doctor can use the device to comprehend the tremor and bradykinesia of patients quickly and with higher accuracy.
Topics: Aged; Humans; Hypokinesia; Monitoring, Physiologic; Movement; Parkinson Disease; Tremor; Wearable Electronic Devices
PubMed: 33540570
DOI: 10.3390/s21030981 -
European Journal of Neurology Dec 2022Reduced facial expression of emotions is a very frequent symptom of Parkinson's disease (PD) and has been considered part of the motor features of the disease. However,...
BACKGROUND AND PURPOSE
Reduced facial expression of emotions is a very frequent symptom of Parkinson's disease (PD) and has been considered part of the motor features of the disease. However, the neural correlates of hypomimia and the relationship between hypomimia and other non-motor symptoms of PD are poorly understood.
METHODS
The clinical and structural brain correlates of hypomimia were studied. For this purpose, cross-sectional data from the COPPADIS study database were used. Age, disease duration, levodopa equivalent daily dose, Unified Parkinson's Disease Rating Scale part III (UPDRS-III), severity of apathy and depression and global cognitive status were collected. At the imaging level, analyses based on gray matter volume and cortical thickness were used.
RESULTS
After controlling for multiple confounding variables such as age or disease duration, the severity of hypomimia was shown to be indissociable from the UPDRS-III speech and bradykinesia items and was significantly related to the severity of apathy (β = 0.595; p < 0.0001). At the level of neural correlates, hypomimia was related to motor regions brodmann area 8 (BA 8) and to multiple fronto-temporo-parietal regions involved in the decoding, recognition and production of facial expression of emotions.
CONCLUSION
Reduced facial expressivity in PD is related to the severity of symptoms of apathy and is mediated by the dysfunction of brain systems involved in motor control and in the recognition, integration and expression of emotions. Therefore, hypomimia in PD may be conceptualized not exclusively as a motor symptom but as a consequence of a multidimensional deficit leading to a symptom where motor and non-motor aspects converge.
Topics: Humans; Parkinson Disease; Cross-Sectional Studies; Hypokinesia; Apathy; Brain
PubMed: 35852918
DOI: 10.1111/ene.15513 -
Neuropsychopharmacologia Hungarica : a... Dec 2014Movement disorders are common in psychiatry. The movement disorder can either be the symptom of a psychiatric disorder, can share a common aetiological factor with it,... (Review)
Review
Movement disorders are common in psychiatry. The movement disorder can either be the symptom of a psychiatric disorder, can share a common aetiological factor with it, or can be the consequence of psychopharmacological therapy. Most common features include tic, stereotypy, compulsion, akathisia, dyskinesias, tremor, hypokinesia and disturbances of posture and gait. We discuss characteristics and clinical importance of these features. Movement disorders are frequently present in mood disorders, anxiety disorders, schizophrenia, catatonia, Tourette-disorder and psychogenic movement disorder, leading to differential-diagnostic and therapeutical difficulties in everyday practice. Movement disorders due to psychopharmacotherapy can be classified as early-onset, late-onset and tardive. Frequent psychiatric comorbidity is found in primary movement disorders, such as Parkinson's disease, Wilson's disease, Huntington's disease, diffuse Lewy-body disorder. Complex neuropsychiatric approach is effective concerning overlapping clinical features and spectrums of disorders in terms of movement disorders and psychiatric diseases.
Topics: Anxiety Disorders; Comorbidity; Compulsive Behavior; Conversion Disorder; Diagnosis, Differential; Dyskinesia, Drug-Induced; Dyskinesias; Gait; Humans; Hypokinesia; Mental Disorders; Mood Disorders; Movement Disorders; Posture; Psychotropic Drugs; Schizophrenia; Stereotypic Movement Disorder; Tic Disorders; Tourette Syndrome; Tremor
PubMed: 25577484
DOI: No ID Found -
Clinical Medicine (London, England) Jul 2019Acute presentations for dementia, particularly dementia with Lewy bodies (DLB), are rare and can pose diagnostic challenges.We present a case of a 75-year-old woman who... (Review)
Review
Acute presentations for dementia, particularly dementia with Lewy bodies (DLB), are rare and can pose diagnostic challenges.We present a case of a 75-year-old woman who was previously fit, well and independent in all activities of daily living. She had no history of psychiatric, cognitive or memory problems. She presented with 2 weeks of sudden onset confusion, paranoia, dizziness and reduced oral intake. Thorough investigations for causes of delirium including blood tests, cerebrospinal fluid analysis obtained via lumbar puncture, electroencephalography, computed tomography, and magnetic resonance imaging were within normal limits. Further neurological examination demonstrated she had subtle Parkinsonian signs (cogwheel rigidity, bradykinesia) and was hypersensitive to small doses of antipsychotic (haloperidol and risperidone). A positive dopamine transporter scan was done confirming a diagnosis of an acute presentation of DLB. She has been commenced on a cholinesterase inhibitor (rivastigmine) and is presently settled in care.
Topics: Acute Disease; Aged; Brain; Confusion; Delirium; Diagnosis, Differential; Female; Humans; Lewy Body Disease
PubMed: 31308115
DOI: 10.7861/clinmedicine.19-4-327 -
Journal of Parkinson's Disease 2023Patient perspectives on meaningful symptoms and impacts in early Parkinson's disease (PD) are lacking and are urgently needed to clarify priority areas for monitoring,...
BACKGROUND
Patient perspectives on meaningful symptoms and impacts in early Parkinson's disease (PD) are lacking and are urgently needed to clarify priority areas for monitoring, management, and new therapies.
OBJECTIVE
To examine experiences of people with early-stage PD, systematically describe meaningful symptoms and impacts, and determine which are most bothersome or important.
METHODS
Forty adults with early PD who participated in a study evaluating smartwatch and smartphone digital measures (WATCH-PD study) completed online interviews with symptom mapping to hierarchically delineate symptoms and impacts of disease from "Most bothersome" to "Not present," and to identify which of these were viewed as most important and why. Individual symptom maps were coded for types, frequencies, and bothersomeness of symptoms and their impacts, with thematic analysis of narratives to explore perceptions.
RESULTS
The three most bothersome and important symptoms were tremor, fine motor difficulties, and slow movements. Symptoms had the greatest impact on sleep, job functioning, exercise, communication, relationships, and self-concept- commonly expressed as a sense of being limited by PD. Thematically, most bothersome symptoms were those that were personally limiting with broadest negative impact on well-being and activities. However, symptoms could be important to patients even when not present or limiting (e.g., speech, cognition).
CONCLUSION
Meaningful symptoms of early PD can include symptoms that are present or anticipated future symptoms that are important to the individual. Systematic assessment of meaningful symptoms should aim to assess the extent to which symptoms are personally important, present, bothersome, and limiting.
Topics: Adult; Humans; Parkinson Disease; Tremor; Cognition; Exercise; Hypokinesia
PubMed: 37212071
DOI: 10.3233/JPD-225068 -
Neurobiology of Disease Jun 2023Patients with Parkinson's disease (PD) show impaired short-term potentiation (STP) mechanisms in the primary motor cortex (M1). However, the role played by this...
Patients with Parkinson's disease (PD) show impaired short-term potentiation (STP) mechanisms in the primary motor cortex (M1). However, the role played by this neurophysiological abnormality in bradykinesia pathophysiology is unknown. In this study, we used a multimodal neuromodulation approach to test whether defective STP contributes to bradykinesia. We evaluated STP by measuring motor-evoked potential facilitation during 5 Hz-repetitive transcranial magnetic stimulation (rTMS) and assessed repetitive finger tapping movements through kinematic techniques. Also, we used transcranial alternating current stimulation (tACS) to drive M1 oscillations and experimentally modulate bradykinesia. STP was assessed during tACS delivered at beta (β) and gamma (γ) frequency, and during sham-tACS. Data were compared to those recorded in a group of healthy subjects. In PD, we found that STP was impaired during sham- and γ-tACS, while it was restored during β-tACS. Importantly, the degree of STP impairment was associated with the severity of movement slowness and amplitude reduction. Moreover, β-tACS-related improvements in STP were linked to changes in movement slowness and intracortical GABA-A-ergic inhibition during stimulation, as assessed by short-interval intracortical inhibition (SICI). Patients with prominent STP amelioration had greater SICI reduction (cortical disinhibition) and less slowness worsening during β-tACS. Dopaminergic medications did not modify β-tACS effects. These data demonstrate that abnormal STP processes are involved in bradykinesia pathophysiology and return to normal levels when β oscillations increase. STP changes are likely mediated by modifications in GABA-A-ergic intracortical circuits and may represent a compensatory mechanism against β-induced bradykinesia in PD.
Topics: Humans; Parkinson Disease; Hypokinesia; Motor Cortex; Transcranial Magnetic Stimulation; Evoked Potentials, Motor; gamma-Aminobutyric Acid
PubMed: 37120094
DOI: 10.1016/j.nbd.2023.106137 -
Progress in Neuro-psychopharmacology &... Dec 2022Huntington's disease (HD) is a neurodegenerative disorder, characterized by motor dysfunction, psychiatric disturbance, and cognitive decline. In the early stage of HD,...
Huntington's disease (HD) is a neurodegenerative disorder, characterized by motor dysfunction, psychiatric disturbance, and cognitive decline. In the early stage of HD, occurs a decrease in dopamine D receptors and adenosine A receptors (AR), while in the late stage also occurs a decrease in dopamine D receptors and adenosine A receptors (AR). Adenosine exhibits neuromodulatory and neuroprotective effects in the brain and is involved in motor control and memory function. 3-Nitropropionic acid (3-NPA), a toxin derived from plants and fungi, may reproduce HD behavioral phenotypes and biochemical characteristics. This study investigated the effects of acute exposure to CPA (AR agonist), CGS 21680 (AR agonist), caffeine (non-selective of AR and AR antagonist), ZM 241385 (AR antagonist), DPCPX (AR antagonist), dipyridamole (inhibitor of nucleoside transporters) and EHNA (inhibitor of adenosine deaminase) in an HD pharmacological model induced by 3-NPA in adult zebrafish. CPA, CGS 21680, caffeine, ZM 241385, DPCPX, dipyridamole, and EHNA were acutely administered via i.p. in zebrafish after 3-NPA (at dose 60 mg/kg) chronic treatment. Caffeine and ZM 241385 reversed the bradykinesia induced by 3-NPA, while CGS 21680 potentiated the bradykinesia caused by 3-NPA. Moreover, CPA, caffeine, ZM 241385, DPCPX, dipyridamole, and EHNA reversed the 3-NPA-induced memory impairment. Together, these data support the hypothesis that AR antagonists have an essential role in modulating locomotor function, whereas the activation of AR and blockade of AR and AR and modulation of adenosine levels may reduce the memory impairment, which could be a potential pharmacological strategy against late-stage symptoms HD.
Topics: Adenosine; Animals; Caffeine; Dipyridamole; Dopamine; Hypokinesia; Nitro Compounds; Propionates; Receptor, Adenosine A2A; Zebrafish
PubMed: 35843370
DOI: 10.1016/j.pnpbp.2022.110602 -
NeuroImage Apr 2019Parkinson's disease causes a characteristic combination of motor symptoms due to progressive neurodegeneration of dopaminergic neurons in the substantia nigra pars... (Review)
Review
Parkinson's disease causes a characteristic combination of motor symptoms due to progressive neurodegeneration of dopaminergic neurons in the substantia nigra pars compacta. The core impairment of dopaminergic neurotransmission has motivated the use of functional magnetic resonance imaging (fMRI) in patients with Parkinson's disease to elucidate the role of dopamine in motor control and cognition in humans. Here we review the main insights from functional brain imaging in Parkinson's disease. Task-related fMRI revealed many disease-related alterations in brain activation patterns. However, the interpretation of these findings is complicated by the fact that task-dependent activity is influenced by complex interactions between the amount of dopaminergic neurodegeneration in the task-relevant nuclei, the state of medication, genetic factors and performance. Despite these ambiguities, fMRI studies in Parkinson's disease demonstrated a central role of dopamine in the generation of movement vigour (bradykinesia) and the control of excessive movements (dyskinesia), involving changes of both activity and connectivity of the putamen, premotor and motor regions, and right inferior frontal gyrus (rIFG). The fMRI studies addressing cognitive flexibility provided convergent evidence for a non-linear, U-shaped, relationship between dopamine levels and performance. The amount of neurodegeneration in the task-relevant dopaminergic nuclei and pharmacological dopamine replacement can therefore move performance either away or towards the task-specific optimum. Dopamine levels also strongly affect processing of reward and punishment for optimal learning. However, further studies are needed for a detailed understanding of the mechanisms underlying these effects.
Topics: Cognitive Dysfunction; Dopamine; Executive Function; Humans; Hyperkinesis; Hypokinesia; Neuroimaging; Parkinson Disease; Reward
PubMed: 30465864
DOI: 10.1016/j.neuroimage.2018.11.021