Assessment of Cognitive and Motor Skills in Parkinson's Disease by a Robotic Object Hitting Game.

Winnugroho Wiratman,Kohei Asano,Shunsuke Kobayashi,Yoshikazu Ugawa,Fang-Yu Chang

doi:10.3389/fneur.2019.00019

Winnugroho Wiratman, Kohei Asano + Show 3 more

Open Access

https://doi.org/10.3389/fneur.2019.00019

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Abstract

Parkinson's disease (PD) patients experience various symptoms including extrapyramidal motor disturbances and cognitive impairments, which cause difficulties in daily life. However, PD patients have rarely been studied under realistic task situations that require high-level interaction of cognitive and motor skills. The aim of this study was to investigate the contribution of cognitive and motor factors to the performance of PD patients under high cognitive and kinematic loads. Twenty-six PD patients and 14 control subjects participated in the study. The PD patients performed a task involving hitting targets and avoiding distractors in levodopa On and Off states. A robotic manipulandum device recorded the numbers of target and distractor hits and hand kinematics, including movement area and speed. Performance on standard cognitive batteries and the Movement Disorder Society – Unified Parkinson's Disease Rating Scale motor scores were examined. The results indicated that the PD patients hit significantly fewer targets and more distractors than did the controls (p < 0.05). In PD patients, the average hand speed was slower and the area of hand movement was smaller than those of the control subjects (p < 0.001). Levodopa significantly increased the average hand speed and movement area (p < 0.01), but levodopa had an insignificant effect on the number of correct targets hit and erroneous distractor hits. The scores of cognitive batteries predicted the performance with regard to both targets hit and distractor avoidance. Our results were indicative of a dynamic interaction between cognitive and kinematic skills while the PD patients performed a virtual reality game. Single-dose levodopa enhanced kinematic capacity, and the global intelligence level predicted game performance.

Highlights

Parkinson’s disease (PD) is a neurodegenerative disease that manifests cardinal motor symptoms of bradykinesia, rigidity, resting tremor, and postural instability
We examined 26 PD patients and 14 control subjects by using a robotic object hitting game that required visual discrimination of the objects and accurate motor control
The clinical score of motor symptoms (i.e., MDS-UPDRS part III) of PD patients predicted the number of targets hit and distractors hit (Table 2)

Summary

Introduction

Parkinson’s disease (PD) is a neurodegenerative disease that manifests cardinal motor symptoms of bradykinesia, rigidity, resting tremor, and postural instability. Clinicians have become increasingly aware of non-motor symptoms of PD. Muslimovic et al [1] reported that approximately 25% of de novo PD patients present with cognitive deficits. Varalta et al [4] reported that PD patients exhibit problems in balance skills when their executive function is more compromised. Dahdal et al [5] reported that, in PD patients, precision finger movements are more impaired when mild cognitive impairment is present. Tasks that require both cognitive and motor skills have been used in some studies for the purpose of rehabilitation and prediction of functional prognosis after stroke [6, 7]. Because motor and non-motor symptoms coexist in PD patients, such integrative and comprehensive approach is important to the understanding of the real-life conditions of PD patients

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