Daytime Motor Activity Research Articles

Discrepancy between wrist-actigraph and polysomnographic measures of sleep in patients with stable heart failure and a novel approach to evaluating discrepancy.

Wrist-actigraphy is often used to measure sleep characteristics in a variety of populations, but discrepancies between actigraphic and polysomnographic measures have been noted in populations experiencing poor sleep quality. The purpose of this study is to examine the discrepancy between these measures and risk factors for discrepancy in people with heart failure using a novel index. We used sleep measures simultaneously recorded by actigraphy and polysomnography, and clinical data from a cross-sectional study of 155 patients with heart failure (age=60.5 [16.1]years; 65.2% male) recruited from evidence-based heart failure disease management programmes. The discrepancy and consistency between the two measures were evaluated using Bland-Altman plots, intra-class correlations and a newly developed index that represents activity counts in wake episodes. Overall, participants had short total sleep time (327.7 [95.9]min) and poor sleep efficiency (71.3 [16.0]%) on polysomnography. The discrepancies between sleep measures were small in patients less than 60years old, and there was excellent consistency (intra-class correlation=0.81) compared with older patients who had poorer consistency (intra-class correlation=0.53) on total sleep time. Higher daytime motor activity, poor sleep quality and more severe insomnia were associated with smaller discrepancies in older, but not younger, patients, and associations were more sensitively detected by the new index. These findings suggest the importance of aging, disability and co-morbidity that may influence motor activity from which sleep estimates are scored with actigraphy. The new index may be useful in identifying factors associated with the correspondence between actigraphy and polysomnography.

Dysregulation of objectively assessed 24-hour motor activity patterns as a potential marker for bipolar I disorder: results of a community-based family study

There has been a growing number of studies that have employed actigraphy to investigate differences in motor activity in mood disorders. In general, these studies have shown that people with bipolar disorders (BPDs) tend to exhibit greater variability and less daytime motor activity than controls. The goal of this study was to examine whether patterns of motor activity differ in euthymic individuals across the full range of mood disorder subtypes (Bipolar I (BPI), Bipolar II (BPII) and major depression (MDD)) compared with unaffected controls in a community-based family study of mood spectrum disorders. Minute-to-minute activity counts derived from actigraphy were collected over a 2-week period for each participant. Prospective assessments of the level, timing and day-to-day variability of physical activity measures were compared across diagnostic groups after controlling for a comprehensive list of potential confounding factors. After adjusting for the effects of age, sex, body mass index (BMI) and medication use, the BPI group had lower median activity intensity levels across the second half of the day and greater variability in the afternoon compared with controls. Those with a history of BPII had increased variability during the night time compared with controls, indicating poorer sleep quality. No differences were found in the average intensity, variability or timing of activity in comparisons between other mood disorder subgroups and controls. Findings confirm evidence from previous studies that BPI may be a manifestation of a rhythm disturbance that is most prominent during the second half of the day. The present study is the largest study to date that included the full range of mood disorder subgroups in a nonclinical sample that increases the generalizability of our findings to the general community. The manifestations of activity patterns outside of acute episodes add to the accumulating evidence that dysregulation of patterns of activity may constitute a potential biomarker for BPD.

Actigraphic assessment of sleep/wake behavior in central disorders of hypersomnolence

ObjectiveTo evaluate the reliability of actigraphy to distinguish the features of estimated daytime and nighttime sleep between patients with central disorders of hypersomnolence and healthy controls. MethodsThirty-nine drug-naïve patients with Narcolepsy Type 1, twenty-four drug-naïve patients with Idiopathic Hypersomnia, and thirty age- and sex- matched healthy controls underwent seven days of actigraphic and self-report monitoring of sleep/wake behavior. The following variables were examined: estimated time in bed (eTIB), estimated total sleep time, estimated sleep latency (eSOL), estimated sleep efficiency, estimated wake after sleep onset, number of estimated awakenings (eAwk), number of estimated awakenings longer than 5 minutes, estimated sleep motor activity (eSMA), number of estimated naps, mean duration of the longest estimated nap (eNapD), and daytime motor activity. ResultsAll actigraphic parameters significantly differentiated the three groups, except eTIB and eSOL. A discriminant score computed combining actigraphic parameters from nighttime (eSMA, eAwk) and daytime (eNapD) periods showed a wide area under the curve (0.935) and a good balance between positive (95%) and negative predictive (87%) values in Narcolepsy Type 1 cases. ConclusionActigraphy provided a reliable objective measurement of sleep quality and daytime napping behavior able to distinguish central disorders of hypersomnolence and in particular Narcolepsy Type 1. The nycthemeral profile, combined with a careful clinical evaluation, may be an ecological information, useful to track disease course.

Decreased Daytime Motor Activity Associated With Apathy in Alzheimer Disease: An Actigraphic Study

Across all stages of Alzheimer disease (AD), apathy is the most common neuropsychiatric symptom. Studies using the Neuropsychiatric Inventory (NPI) have found that apathy is present in up to 70% of individuals with Alzheimer disease. One of the main difficulties in assessing apathy and other neuropsychiatric symptoms is the absence of reliable, objective measures. Motor activity assessment using ambulatory actigraphy could provide an indirect, objective evaluation of apathy. The aim of our study was to assess the relationship between apathy and daytime motor activity in AD, using ambulatory actigraphy. One hundred seven AD outpatients wore a wrist actigraph (Motionlogger) during seven consecutive 24-hour periods to evaluate motor activity. Participants were divided into two subgroups according to their apathy subscores on the NPI: individuals with apathy (NPI-apathy subscores >4) and those without. Daytime mean motor activity scores were compared between the two subgroups. Individuals with AD who had symptoms of apathy (n = 43; age = 79 ± 4.7 years; Mini-Mental State Examination = 20.9 ± 4.8) had significantly lower daytime mean motor activity than AD patients without apathy (n = 64; age = 76.3 ± 7.7; Mini-Mental State Examination = 21.5 ± 4.7), while nighttime mean motor activity did not significantly differ between the two subgroups. Ambulatory actigraphy could be added to currently used questionnaires as a simple, objective technique for assessing apathy in the routine assessment of AD patients.

A role for the habenula in the regulation of locomotor activity cycles.

Although much is known about the regulation of the circadian rest-activity cycle by the hypothalamic suprachiasmatic nucleus in nocturnal rodents, little is known about the neural substrates that regulate the temporal organization of nocturnal activity within the active phase. In this report, data are presented in Syrian hamsters to implicate the habenula - believed to be involved in motivation, reward and motor control--as a candidate site for such a role. First, by examining hamsters during the day and night and by introducing a 'novel' running wheel in order to induce daytime motor activity, we showed that immunoreactive c-Fos expression in the lateral and medial habenula is related to motor activity/arousal. Second, by transecting the habenula's major efferent pathway (fasciculus retroflexus), we showed that the interruption of habenula neural output alters the daily amount of motor activity, lengthens the period of the circadian rest-activity rhythm and disrupts the species-typical pattern of nocturnal motor activity, measured as either wheel-running behavior or general locomotor activity. Instead of the usual pattern of night-time locomotion, characterized by a prolonged bout of elevated activity in the early night followed by shorter sporadic bouts or the cessation of activity altogether, lesioned animals exhibited a more homogeneous, undifferentiated temporal profile extending across the night. These data suggest a previously unrecognized function of the habenula whereby it regulates the temporal pattern of activity occurring within a circadian rest-activity window set by the suprachiasmatic nucleus.

ACTIGRAPHIC EVIDENCE FOR NIGHT-TIME HYPERKINESIA IN PARKINSON’S DISEASE

Parkinson's disease is a common motor disorder that not only leads to motor symptoms but also autonomic dysregulation, mental changes, sensory disturbances, and sleep disorders such as increased daytime sleepiness and sleep fragmentation. The aim of this study was to find out how the daytime and night-time motor activity levels in individuals without motor disorders differ from patients with Parkinson's disease. Daytime and night-time motor activity levels in 17 PD patients and 69 controls were measured for three consecutive days and nights via actigraphy, a method of continuous long-term assessment of activity levels. A ratio between night-time and daytime motor activity was calculated. PD patients had a 1.5–2-fold lower daytime motor activity but also showed 1.5–2-fold higher motor activity at night time. Older controls showed a lower daytime but similar night-time motor activity when compared to younger controls. A ratio of night-time to daytime motor activity could clearly distinguish controls and patients. The possibility to distinguish patients and controls by the ratio of night-time to daytime motor activity is worth further investigation.

Longitudinal changes of day-time and night-time gross motor activity in clinical responders and non-responders of major depression

Longitudinal changes of day-time and night-time gross motor activity in clinical responders and non-responders of major depression

Effects of adjunctive antidepressant therapy with quetiapine on clinical outcome, quality of sleep and daytime motor activity in patients with treatment‐resistant depression

To investigate the effects of antidepressant therapy plus quetiapine on major depression, motor activity, daytime sleepiness and quality of sleep. Patients (N = 27) with major depressive disorder received a standard antidepressant treatment (Venlafaxine, Escitalopram) plus flexible dose of quetiapine. Patients' depression was monitored with HAM-D-21, motor activity was continuously measured with actigraphy and sleep parameters with the Pittsburgh Sleep Quality Index (PSQI) over 4 weeks. Whereas depression, quality of sleep and daytime sleepiness showed a significant improvement over 4 weeks, change of daytime motor activity was significant only between the wash out period and the last 2 days of the study. Repeated measures of variance indicate an independent influence of quetiapine on improved depression, motor activity and sleep. While we found only a mild decrease of daytime sleepiness during the first week of treatment, the further decline of daytime sleepiness got significant after 2 weeks of treatment with quetiapine, even at high mean daily doses and despite the sedative effects of quetiapine. Antidepressant treatment plus quetiapine is possibly a suitable treatment strategy to improve clinical depression, quality of sleep and motor activity. Future research is needed to understand the pharmacological interactions between antidepressants and quetiapine in major depression.

Quantitative assessment of daytime motor activity provides a responsive measure of functional decline in patients with Huntington's disease.

Voluntary motor impairment is a functionally important aspect of Huntington's disease (HD). Therefore, quantitative assessment of disturbed voluntary movement might be important in follow-up. We investigated the relation between quantitatively assessed daytime motor activity and symptom severity in HD and evaluated whether assessment of daytime motor activity is a responsive measure in the follow-up of patients. Sixty-four consecutive HD patients and 67 age- and sex-matched healthy controls were studied. Daytime motor activity was recorded using a wrist-worn activity monitor that counts all movements during a period of five consecutive days. Patients were rated clinically for voluntary motor impairment, dyskinesias, posture & gait, depression, cognitive impairment and functional capacity. Follow-up was available from 40 patients (mean follow-up 2.0 years) and 29 controls (mean follow-up 5.9 years). Despite chorea, patients had less daytime motor activity than controls (P < 0.005). This hypokinesia correlated with impaired voluntary movements (r = 0.37; P < 0.01), disturbed posture & gait (r = 0.38; P < 0.005) and especially with reduced functional capacity (r = 0.51; P < 0.0005). During follow-up, hypokinesia remained unchanged in clinically stable patients, but became worse in those whose functional disability progressed (P < 0.005). Hypokinesia seems a core symptom of HD which is related to functional capacity. Actimetric assessment of hypokinesia is responsive to disease progression and can be used as an objective tool for follow-up.

Associations of age and gender with activity and sleep.

Associations between age/gender and activity/sleep (measured by actigraphs) in 66 healthy children aged 5-12 y were studied. With increasing age, daytime motor activity and total sleep time decreased and activity pattern changed. No gender differences were found. It was concluded that in this age group there is an age-dependent change in the amount and pattern of motor activity and sleep due to developmental and/or environmental factors.

Associations of age and gender with activity and sleep

Associations between age/gender and activity/sleep (measured by actigraphs) in 66 healthy children aged 5–12 y were studied. With increasing age, daytime motor activity and total sleep time decreased and activity pattern changed. No gender differences were found.It was concluded that in this age group there is an age‐dependent change in the amount and pattern of motor activity and sleep due to developmental and/or environmental factors.

Actigraphic monitoring (actigraphy) of circadian locomotor activity in schizophrenic patients with acute neuroleptic-induced akathisia

Background: Actigraphy is a quantitative method for measurement of motor activity. In the present study we used actigraphy to examine diurnal variations in locomotor activity of schizophrenic patients with neuroleptic-induced akathisia (NIA). Method: Thirty-two schizophrenic patients, 16 with NIA and 16 without (DSM-IV criteria) underwent 24-h actigraphic monitoring. Clinical assessments of NIA were conducted with Barnes Akathisia Scale (BAS) at 08:00, 12:00, 16:00 and 20:00. Sleep parameters (duration, latency, continuity and efficacy) were assessed by actigraphy. Sleep quality was evaluated by a self-rated sleep questionnaire. Results: NIA patients demonstrated persistent higher daytime motor activity from 11:30 to 14:15 and from 18:00 to 21:00 than controls. There were no differences between the groups in nighttime motor activity, confirming clinical observations that NIA tends to disappear during sleep. Subject’s sleep assessments were similar in the two groups. Conclusions: Actigraphy seems to be a reliable, non-invasive, method of measuring motor activity in patients with NIA. Its sensitivity and specificity as an objective quantitative diagnostic instrument in patients with NIA merits further investigation.

Effects of short duration morning bright light in healthy elderly. II: sleep and motor activity.

Subjective sleep feelings and motor activity were measured in seven healthy elderly subjects for 6 days. The subjects were exposed to bright light (6000 lux) for 30 min in the morning or instructed to sit in front of a desktop lighting device without light. The average level of motor activity during the night was significantly decreased in the bright light condition, compared with the controlled condition. However, daytime motor activity did not show significant differences between the two conditions. From these findings, even a short duration of morning bright light is effective in maintaining sleep without changing daytime activity.

Dopamine–glutamate interactions in the striatum: behaviourally relevant modification of excitotoxicity by dopamine receptor-mediated mechanisms

The two most important afferent projections to the striatum contain glutamate and dopamine, respectively. Excitotoxic damage resulting from excessive stimulation of the N-methyl- d-aspartate subtype of glutamate receptor has been implicated in pathophysiology of ischaemic stroke, hypoglycaemic brain damage and Huntington's disease. We studied the ability of the dopamine system to modify the anatomical, neurochemical and behavioural consequences of glutamatergic toxicity in the striatum. In a first set of experiments, the specific N-methyl- d-aspartate receptor agonist quinolinate was injected unilaterally into the striatum of rats pretreated with one of (i) intraperitoneal (i.p.) saline (controls); (ii) i.p. haloperidol, a D 2 dopamine receptor agonist; or (iii) 6-hydroxydopamine lesion of the ipsilateral nigrostriatal tract. Quinolinate-induced striatal damage, as assessed by morphometric and neurochemical criteria, was significantly attenuated in the animals with 6-hydroxydopamine lesions and in those pretreated with haloperidol, compared with saline-pretreated controls. There were no significant differences between the 6-OHDA and haloperidol groups. In a second set of experiments, animals received (i) bilateral intrastriatal quinolinate plus perioperative i.p. saline; (ii) bilateral intrastriatal quinolinate plus i.p. haloperidol; or (iii) bilateral intrastriatal saline. Again, the quinolinate-lesioned animals treated with perioperative haloperidol had significantly less striatal damage than the bilateral quinolinate rats. Behavioural assessment in the Morris Water Maze showed the bilateral quinolinate+haloperidol group to be significantly less impaired on a spatial acquisition task than the bilateral quinolinate animals. Measures of spontaneous daytime motor activity showed significant differences in average speed and rest time between the bilateral quinolinate+haloperidol rats and the bilateral quinolinate group. The performance of the bilateral quinolinate+haloperidol group was not significantly different from that of controls on any of the behavioural tasks. These results indicate an important role for D 2 dopamine receptor-mediated mechanisms in striatal excitotoxicity. Since the excitotoxic process involves the same fundamental signalling mechanism that is involved in normal glutamatergic transmission, these findings imply an ability of D 2 receptor blockade to modify glutamate signalling in the striatum. These results may have implications for treatment strategies in ischaemic stroke, hypoglycaemic brain damage and schizophrenia.

Hypokinesia in Huntington's disease.

Motor activity was quantitatively assessed over a period of 5 days using a wrist-worn activity monitor in 14 patients with Huntington's disease (of whom 4 used neuroleptic drugs) and 14 age- and sex-matched healthy controls. Additionally, patients were rated for dementia, depression, clinical impairment of motor tasks, chorea, and disability. A significant decrease in daytime motor activity was observed in patients compared with controls, suggesting hypokinesia rather than hyperkinesia. Hypokinesia tended to be more severe in patients using neuroleptic drugs. Lower activity levels were significantly related to lower scores of functional disability, but not to other clinical measures. We conclude that hypokinesia is a prominent manifestation in Huntington's disease that is worsened by the use of neuroleptics.

Increased motor activity and recurrent manic episodes: Predictors of rapid relapse in remitted bipolar disorder patients after lithium discontinuation

Ten patients with remitted bipolar illness on lithium maintenance therapy underwent placebo-controlled lithium discontinuation. Clinical ratings and recording of sleep-wake activity using wrist-worn actigraphs were carried out before and after lithium discontinuation. Seven patients experienced relapse into mania or hypomania within the first 3 months after lithium discontinuation. Actigraphic recordings revealed that patients who relapsed had higher baseline levels of daytime motor activity than patients without relapse. This may suggest that motor activity can be a sensitive marker of subclinical manic tendencies and early relapse following lithium discontinuation.

Effect of p-chlorophenylalanine on cerebral serotonin binding, serotonin concentration and motor activity in the rat

The effect of p-chlorophenylalanine (PCPA) on the specific binding of 3H-serotonin (5-HT) was investigated in crude membrane preparations of the rat forebrain. The level of cerebral 5-HT and 5-hydroxyindoleacetic acid were concomitantly determined. A single dose of PCPA (300 mg/kg i.p.) increased specific binding at a low concentration of 3H-5-HT within 24 h by more than 100%. The time course of the elevation of specific binding was mirrored by the reduction in the 5-HT level. However, 8--10 days after drug administration, specific binding was close to the control level, while 5-HT was still significantly reduced. A Scatchard analysis revealed that the apparent affinity was significantly increased (KD reduced) during the initial period after PCPA administration, whereas the number of binding sites (BMax) was little changed. In contrast, after reported injections of PCPA (3 injections of 300 mg/kg at 6--8 day intervals, or 100 mg/kg/day for up to 12 days) leading to a prolonged 5-HT depletion, BMax was significantly increased, while KD tended to be restored towards the baseline level. Daily injections of PCPA (100 mg/kg) for 12 days resulted in a transitory increase in day-time motor activity with a maximum on drug day 3, and in a persistent reduction of night-time activity. It is concluded that the initial PCPA-induced decrease in KD was due to a reduced competition for binding sites by the endogenous 5-HT, whereas the increase of BMax after a prolonged 5-HT depletion may reflect a 5-HT receptor supersensitivity.