Gait Disturbance Research Articles

Continuous Gait Phase Estimation for Multi-Locomotion Tasks Using Ground Reaction Force Data.

Existing studies on gait phase estimation generally involve walking experiments using inertial measurement units under limited walking conditions (WCs). In this study, a gait phase estimation algorithm is proposed that uses data from force sensing resistors (FSRs) and a Bi-LSTM model. The proposed algorithm estimates gait phases in real time under various WCs, e.g., walking on paved/unpaved roads, ascending and descending stairs, and ascending or descending on ramps. The performance of the proposed algorithm is evaluated by performing walking experiments on ten healthy adult participants. An average gait estimation accuracy exceeding 90% is observed with a small error (root mean square error = 0.794, R2 score = 0.906) across various WCs. These results demonstrate the wide applicability of the proposed gait phase estimation algorithm using various insole devices, e.g., in walking aid control, gait disturbance diagnosis in daily life, and motor ability analysis.

Clinical markers of Charcot-Marie-Tooth disease (own experience)

Charcot-Marie-Tooth disease is also called hereditary motor and sensory neuropathy. It is a genetically determined disease that has different variants of inheritance whose substratum is neuromuscular disorders. It may begin during childhood or later in life. Scientists have identified and described more than thirty genetic mutations that form an individual unique passport of violations of the sequence of a group of organic compounds or nucleotides in nucleic acid molecules. There are autosomal dominant, autosomal recessive and X-linked types of genetic inheritance of Charcot-Marie-Tooth disease. This pathology was first described in 1886 and affects about 10 to 40 per 100,000 population. More than 15,000 cases of Charcot-Marie-Tooth disease have been registered in Ukraine. It should be noted that peripheral myelin protein 22 became the first described gene causing Charcot-Marie-Tooth disease. Autosomal dominant Charcot-Marie-Tooth type 1 is the most common form of the disease. When observing patients, a neurologist pays attention to gait disturbances (steppage gait), foot distortion (pes cavus), distal hypotrophy, decrease or absence of tendon and periosteal reflexes, weakness and loss of sensitivity in the distal parts of the limbs. Hypotrophic changes in the limbs are continuously progressive. As a result of muscle atrophy and foot deformity, high-arched feet and extension of the big toe (Friedreich’s foot) are formed. To date, no pathogenetically substantiated treatment exists for Charcot-Marie-Tooth disease, but a multi-vector approach to comprehensive rehabilitation measures creates the necessary conditions to effectively control the manifestations of the inevitable progression of this pathology.

Assessment of the Postoperative Progression in Patients With Intramedullary Spinal Cord Tumors Based on the Severity of Preoperative Gait Disturbance.

Retrospective comparative study. This study aimed to determine whether the severity of preoperative gait disturbance remains after surgical resection in patients with intramedullary spinal cord tumors (IMSCTs), and to identify any factors influencing poor improvement in postoperative gait disturbance. The study included a total of 128 patients with IMSCTs requiring surgical excision between 2006 and 2019. Based on the degree of preoperative gait disturbance assessed by the modified McCormick scale (MMCS) grade, patients were categorized into Mild (I-II) and Severe (III-V) groups. The mean postoperative follow-up period was 55.5 ± 34.3months, and demographic and surgical characteristics were compared between the two groups. Significant differences were observed in age at surgery, tumor location, tumor size, estimated blood loss, intraoperative motor-evoked potential disappearance, extent of resection, and tumor histopathology between the Mild and Severe groups. In the Mild group, at the final follow-up, only 7.3% of patients experienced improvement, 56.0% showed no changes, and 36.7% experienced deterioration. Conversely, in the Severe group, 26.3% of patients experienced improvement, 31.6% showed no changes, and 42.1% experienced deterioration. Tumor location and age at surgery were identified as factors correlated with poor improvement in postoperative gait disturbance in the Mild group. Irrespective of the preoperative gait disturbance degree, approximately 40% of patients with IMSCTs experienced deterioration in gait after tumor resection. For preoperative MMCS grade I-II cases, older age at surgery and thoracic IMSCTs would be important factors associated with poor improvement in postoperative gait disturbance.

‘Watkins’ & ‘Watkins2.0’: Smart phone applications (Apps) for gait-assessment in normal pressure hydrocephalus and decompensated long-standing overt ventriculomegaly

ObjectiveGait disturbance is one of the features of normal pressure hydrocephalus (NPH) and decompensated long-standing overt ventriculomegaly (LOVA). The timed-up-and-go (TUG) test and the timed-10-m-walking test (10MWT) are frequently used assessments tools for gait and balance disturbances in NPH and LOVA, as well as several other disorders. We aimed to make smart-phone apps which perform both the 10MWT and the TUG-test and record the results for individual patients, thus making it possible for patients to have an objective assessment of their progress. Patients with a suitable smart phone can perform repeat assessments in their home environment, providing a measure of progress for them and for their clinical team.Methods10MWT and TUG-test were performed by 50 healthy adults, 67 NPH and 10 LOVA patients, as well as 5 elderly patients as part of falls risk assessment using the Watkins2.0 app. The 10MWT was assessed with timed slow-pace and fast-pace. Statistical analysis used SPSS (version 25.0, IBM) by paired t-test, comparing the healthy and the NPH cohorts. Level of precision of the app as compared to a clinical observer using a stopwatch was evaluated using receiver operating characteristics curve.ResultsAs compared to a clinical observer using a stopwatch, in 10MWT the app showed 100% accuracy in the measure of time taken to cover distance in whole seconds, 95% accuracy in the number of steps taken with an error ± 1–3 steps, and 97% accuracy in the measure of total distance covered with error of ± 0.25–0.50 m. The TUG test has 100% accuracy in time taken to complete the test in whole seconds, 97% accuracy in the number of steps with an error of ± 1–2 steps and 87.5% accuracy in the distance covered with error of ± 0.50 m. In the measure of time, the app was found to have equal sensitivity as an observer. In measure of number of steps and distance, the app demonstrated high sensitivity and precision (AUC > 0.9). The app also showed significant level of discrimination between healthy and gait-impaired individuals.Conclusion‘Watkins’ and ‘Watkins2.0’ are efficient apps for objective performance of 10MWT and the TUG-test in NPH and LOVA patients and has application in several other pathologies characterised by gait and balance disturbance.

Patterns of change in propulsion force and late braking force in patients with stroke walking at comfortable and fast speeds

Increased propulsion force (PF) in the paretic limb is associated with improved walking speed in patients with stroke. However, late braking force (LBF), an additional braking force occurring between PF onset and toe-off, is present in a subset of stroke patients. Few studies have investigated the changes in LBF and walking speed in these patients. This study aimed to elucidate the patterns of change in PF and LBF during fast gait in hemiplegics and identify potential compensatory strategies based on the LBF patterns. Data from 100 patients with stroke walking at both comfortable (mean, 0.79 ± 024 m/s) and fast speeds (mean, 1.06 ± 0.35 m/s) were analyzed retrospectively stroke using a 3D motion analyzer. PF was higher during fast-speed walking than that during comfortable-speed walking in all patients, while LBF showed both decreasing and increasing trends during fast-speed walking. In the LBF increasing pattern, a reduction in in-phase coordination of the shank and foot during the pre-swing phase was observed, along with an increase in pelvic hike during fast-speed walking compared to those in the decreasing LBF pattern. Our findings demonstrate that alterations in LBF patterns are associated with gait deviations in patients with stroke at fast speeds.

Topography of Cholinergic Nerve Terminal Vulnerability and Balance Self-Efficacy in Parkinson's Disease.

Postural instability and gait disturbances (PIGD) represent a significant cause of disability in Parkinson's disease (PD). Cholinergic system dysfunction has been implicated in falls in PD. The occurrence of falls typically results in fear of falling (FoF) that in turn may lead to poorer balance self-efficacy. Balance self-efficacy refers to one's level of confidence in their ability to balance while completing activities of daily living like getting dressed, bathing, and walking. Lower self-efficacy, or greater FoF during these activities is a function of motor, cognitive, and emotional impairments and may impact quality of life in PD. Unlike known cholinergic reduction, especially in the right lateral geniculate and caudate nuclei, little is known about the role of cholinergic transporters in FoF or mobility self-efficacy in PD. [18F]fluoroethoxybenzovesamicol ([18F]FEOBV) positron emission tomography (PET) studies were conducted to assess vesicular acetylcholine transporter (VAChT) expression in 126 patients with PD (male (m) = 95, female (f) = 31). Participants had a mean age of 67.3 years (standard deviation (SD) = 7.1) and median Hoehn Yahr stage of 2.5. Patients also completed the Short Falls Efficacy Scale (sFES-I) as a survey measure of concerns about falling. [18F]FEOBV data were processed in Statistical Parametric Mapping (SPM) using a voxel-wise regression model with sFES-I scores as the outcome measure. Reduced [18F]FEOBV binding in tectum, metathalamic (lateral more than medial geniculate nuclei), thalamus proper, bilateral mesiotemporal (hippocampal, parahippocampal, fusiform gyri and fimbriae), and right cerebellar lobule VI significantly associated with higher sFES-I scores (p < 0.05, family-wise error (FWE) correction after Threshold-Free Cluster Enhancement (TFCE)). Unlike the more limited involvement of the brainstem-thalamic complex and caudate nuclei cholinergic topography associated with falls in PD, cholinergic reductions in the extended connectivity between the thalamic complex and the temporal limbic system via the fimbriae associates with FoF. Additional cholinergic changes were seen in the cerebellum. The temporal limbic system plays a role not only in episodic memory but also in spatial navigation, scene and contextual (e.g., emotional) processing. Findings may augur novel therapeutic approaches to treat poor mobility self-efficacy in PD. No: NCT02458430. Registered 18 March, 2015, https://www. gov/study/NCT02458430; No: NCT05459753. Registered 01 July, 2022, https://www. gov/study/NCT05459753.

Non-motor symptoms of Parkinson`s disease-insights from genetics.

Parkinson's disease (PD) is a neurodegenerative disorder characterized by both motor and non-motor symptoms (NMS). NMS including sleep disturbances, depression, anxiety, and constipation are diverse, can precede motor symptoms, and significantly impact patients` quality of life. The severity and type of NMS vary based on age, disease severity, and motor symptoms, and while some respond to dopaminergic treatments, others may be induced or exacerbated by such treatments. NMS also play a role in differentiating PD from drug-induced parkinsonism and are related to gait dysfunction in both early and advanced stages. Genetic factors play a significant role in the development of NMS in PD, with mutations in genes such as SNCA, LRRK2, PRKN, and GBA being associated with severe and early NMS.Familial studies and identification of susceptibility factors have provided insights into the genetic underpinnings of NMS in PD. Neurobehavioral changes, including cognitive decline, are common NMS in PD, and their genetic basis involves a spectrum of mutations shared with other neurodegenerative disorders. Further research is needed to elucidate the functional implications of these genetic factors and their contributions to the pathogenesis of NMS in PD.

Feasibility and usefulness of video-based markerless two-dimensional automated gait analysis, in providing objective quantification of gait and complementing the evaluation of gait in children with cerebral palsy

BackgroundGait analysis aids in evaluation, classification, and follow-up of gait pattern over time in children with cerebral palsy (CP). The analysis of sagittal plane joint kinematics is of special interest to assess flexed knee gait and ankle joint deviations that commonly progress with age and indicate deterioration of gait. Although most children with CP are ambulatory, no objective quantification of gait is currently included in any of the known international follow-up programs. Is video-based 2-dimensional markerless (2D ML) gait analysis with automated processing a feasible and useful tool to quantify deviations, evaluate and classify gait, in children with CP?MethodsTwenty children with bilateral CP with Gross Motor Function Classification Scale (GMFCS) levels I–III, from five regions in Sweden, were included from the national CP registry. A single RGB-Depth video camera, sensitive to depth and contrast, was positioned laterally to a green walkway and background, with four light sources. A previously validated markerless method was employed to estimate sagittal plane hip, knee, ankle kinematics, foot orientation and spatio-temporal parameters including gait speed and step length.ResultsMean age was 10.4 (range 6.8–16.1) years. Eight children were classified as GMFCS level I, eight as II and four as III. Setup of the measurement system took 15 min, acquisition 5–15 min and processing 50 min per child. Using the 2D ML method kinematic deviations from normal could be determined and used to implement the classification of gait pattern, proposed by Rodda et al. 2001.Conclusion2D ML assessment is feasible, since it is accessible, easy to perform and well tolerated by the children. The 2D ML adds consistency and quantifies objectively important gait variables. It is both relevant and reasonable to include 2D ML gait assessment in the evaluation of children with CP.

Gait Characteristics and Deviation Factors of Backward Walking in Patients With Chronic Ankle Instability.

Despite growing applications of backward walking (BW) in assessing and rehabilitating neuromuscular conditions, its effects on gait in chronic ankle instability (CAI) remain unclear. Moreover, linking patient-reported and clinically generated measures is imperative for understanding CAI. Patients with CAI will exhibit worse and compensatory spatio-temporal and kinetic gait parameters during BW, and patient-reported outcomes (PROs) will be correlated significantly with gait parameters. Case-control study. Level 4. A total of 46 volunteers participated (23 per group). Patients filled out scales for pain, functions, and fear-avoidance beliefs before testing. All participants walked 6 times each in both forward and backward conditions, and gait was recorded using the Win-Track system. A 2-way mixed analysis of variance was performed to compare gait parameters. The relationship between PRO and gait outcomes was assessed through the Pearson product correlation coefficient. The CAI group demonstrated prolonged support and swing phases, increased walk-off angle, and plantar pressure area, but decreased step length and plantar pressure versus controls (P < 0.05). The CAI group had a smaller right walk-off angle during BW than FW; the control group showed the opposite (P < 0.05). The left single stance duration was greater in the CAI group, while the right was not (P < 0.05). PRO correlated significantly with gait parameters, particularly spatial parameters (P < 0.05). The CAI group exhibited worse gait parameters during BW. The CAI group exhibited a characteristic compensatory gait pattern. Linking the self-reported scores provides a better representation of gait changes in CAI. These results suggest that BW may be an effective strategy for identifying and evaluating CAI. It may be feasible to apply BW to the rehabilitation of CAI.

Decrease of excessive daytime sleepiness after shunt treatment for normal pressure hydrocephalus.

Sleepiness and apathy are often reported in patients with normal pressure hydrocephalus. However, research on outcomes after shunt surgery has mainly focused on the classical triad symptoms, that is, gait, cognition, and bladder dysfunction. This study aimed to describe the effects of shunt treatment on excessive daytime sleepiness and whether there was a relation to changes in ventricular volume. Pre- and postsurgical excessive daytime sleepiness was investigated using the Epworth sleepiness scale in a sample of 32 patients with normal pressure hydrocephalus who underwent shunt surgery. Data were gathered before surgery and at 1, 2, and 3 months after surgery and with different settings of the shunt. In the total sample, the Epworth sleepiness scale improved by a median of 1.5 points at 1 month after surgery, p = 0.026. The improvement was predominately found in the group (n = 6) with high presurgical daytime sleepiness (Epworth sleepiness scale >12) (median = 12 points, p = 0.035) compared with a median change of 0 points (p = 0.47) in the group with Epworth sleepiness scale ≤12 (n = 26). Between the postsurgical follow-ups, no further change in the Epworth sleepiness scale score was observed. The Epworth sleepiness scale score did not correlate with clinical tests nor with ventricular volume. Daytime sleepiness seems to be another domain of normal pressure hydrocephalus symptomatology in addition to the classical triad that is responsive to treatment, at least when pronounced. The Epworth sleepiness scale is a quick test to administer and could be a valuable addition to pre-surgical screening for treatable symptoms.

Gait assessment in a female rat Sprague Dawley model of disc-associated low back pain

ABSTRACT Purpose Gait disturbances are common in human low back pain (LBP) patients, suggesting potential applicability to rodent LBP models. This study aims to assess the influence of disc-associated LBP on gait in female Sprague Dawley rats and explore the utility of the open-source Gait Analysis Instrumentation and Technology Optimized for Rodents (GAITOR) suite as a potential alternative tool for spontaneous pain assessment in a previously established LBP model. Materials and Methods Disc degeneration was surgically induced using a one-level disc scrape injury method, and microcomputed tomography was used to assess disc volume loss. After disc injury, axial hypersensitivity was evaluated using the grip strength assay, and an open field test was used to detect spontaneous pain-like behavior. Results Results demonstrated that injured animals exhibit a significant loss in disc volume and reduced grip strength. Open field test did not detect significant differences in distance traveled between sham and injured animals. Concurrently, animals with injured discs did not display significant gait abnormalities in stance time imbalance, temporal symmetry, spatial symmetry, step width, stride length, and duty factor compared to sham. However, comparisons with reference values of normal gait reported in prior literature reveal that injured animals exhibit mild deviations in forelimb and hindlimb stance time imbalance, forelimb temporal symmetry, and hindlimb spatial symmetry at some time points. Conclusions This study concludes that the disc injury may have very mild effects on gait in female rats within 9 weeks post-injury and recommends future in depth dynamic gait analysis and longer studies beyond 9 weeks to potentially detect gait.

B - 32 Neurological Problems in Boxers during the 20th Century: a Review and Synthesis

Abstract Objective There are no validated clinical diagnostic criteria for chronic traumatic encephalopathy or traumatic encephalopathy syndrome (TES). To understand the historical clinical condition, its applicability to modern day athletes, and the pathogenesis of clinical problems, we examined the literature in boxers from the 20th century, with specific attention to neurological findings and characteristics of clinical disease progression. Data Selection Data were extracted for 243 boxers included in 45 articles published between 1928 and 1999, including cases from articles originally published in German. The presence or absence of 22 neurological signs and features were extracted. Data Synthesis The most common neurological problems were slurring dysarthria (49%), gait disturbances (44%), and memory loss (36%), with several other problems that were less frequent, including hyperreflexia (25%), ataxia (22%), increased tone (19%), and extensor Babinski sign (16%). Frank dementia appeared in some cases (17%). There were significantly fewer neurological deficits reported in boxers who fought in the latter part of the 20th century compared to boxers who fought earlier in the century. For most cases, there were no comments about whether the neurological problems were progressive (145, 60%). A progressive condition was described in 71 cases (29%) and a stationary or improving condition was described in 27 cases (11%). Canonical neurodegenerative disease-like progression was described in 15 cases (6%). Conclusions Neurological problems associated with boxing-related neurotrauma during the 20th century are the foundation for present day TES. However, the clinical signs and features in the 20th century differ in most ways from the modern criteria for TES.

Efficacy of Transarterial Embolization Using Intermittent Flow Control for Tentorial Dural Arteriovenous Fistula Presenting as Myelopathy: A Technical Report

BackgroundTransarterial embolization (TAE) is generally the endovascular treatment of choice for tentorial dural arteriovenous fistula (dAVF). Although flow control of the feeder vessel has been reported to achieve complete shunt blockade, flow control in the absence of ischemia tolerance of ICA as a feeder has not been reported. we present a case in which treatment by Onyx TAE with intermittent flow control of the meningohypophyseal trunk (MHT) as the feeder was successful for a tentorial dAVF presenting with myelopathy without tolerance of ischemia. MethodsThe intermittent flow control is presented for a tentorial dAVF presenting with myelopathy without tolerance for ischemia. An inflation of the balloon in the internal carotid artery was set for 5 minutes, and the Onyx injection was repeated at intervals of at least 2 minutes. Injections and pauses were repeated to allow Onyx to reach the shunt pouch. ResultsThe patient underwent successful TAE with intermittent flow control for a tentorial dAVF presenting with myelopathy. The disappearance of the shunt was confirmed with gait disturbance resolution postoperatively. ConclusionIntermittent flow control of the MHT using a balloon may be safe and effective for cases showing no tolerance for ischemia.

Cerebellopontine angle metastasis from pancreatic cancer: a case report

Introduction: Pancreatic cancer metastasis to the cerebellopontine angle (CPA) is extremely rare and often misdiagnosed preoperatively. The clinical characteristics and prognosis of this uncommon condition remain largely unknown. Case presentation: We report the case of a 68-year-old male who presented with recurrent headaches, dizziness, and gait disturbances. The patient had undergone pancreaticoduodenectomy for pancreatic head adenocarcinoma two years prior. Preoperative imaging suggested a right CPA meningioma. The patient underwent resection of the CPA tumor under general anesthesia. Postoperative pathology revealed a metastatic pancreatic adenocarcinoma. Despite treatment with adjuvant chemotherapy, the patient developed widespread metastatic disease and succumbed 2 months after the CPA tumor resection. Discussion: The rarity of pancreatic cancer metastasizing to the CPA presents diagnostic challenges, as evidenced by the initial misdiagnosis of meningioma in this case. The clinical presentation can mimic benign conditions, leading to delays in appropriate management. This case underscores the importance of considering metastatic disease in patients with a history of cancer, even when presenting with symptoms typical of more common CPA lesions. Conclusion: Vigilant monitoring is crucial in pancreatic cancer patients, as neurological symptoms may herald metastatic spread to uncommon sites like the CPA. Despite surgical intervention, widespread metastasis can lead to poor outcomes. Early diagnosis and a high index of suspicion are essential for optimal management of these rare cases.

Suspension training improves bilateral isometric strength asymmetry of knee muscles in people with multiple sclerosis

IntroductionMost people with multiple sclerosis are diagnosed with bilateral strength asymmetry in the lower limbs. Strength asymmetry increases muscle metabolic cost, muscle fatigability, postural instability, gait disturbance, imbalance, and risk of falling, and negatively affects the quality of life in PwMS. So far, the effects of rehabilitation exercises on reducing the asymmetric index in this population has not been studied convincingly. The purpose of this study was to investigate the effect of suspension exercise on bilateral isometric strength asymmetry of knee muscles in patients with multiple sclerosis. Materials & methodsIn this randomized controlled trial, twenty-seven female patients were purposively selected as the statistical sample and randomly divided into the control (n = 13, age: 34.72 ± 5.01 years) and exercise (n = 14, age: 37.62 ± 4.58 years) groups. The control group received routine care while the exercise group received the suspension exercise protocol. Isometric muscle strength and bilateral asymmetry were measured at baseline and after 8 weeks. The Biodex isokinetic dynamometer was used to measure the maximal voluntary isometric contraction of the flexor and extensor muscles of the knee. The analysis of covariance was used to analyze the data. ResultsThe isometric strength of the knee extensor muscles in the weak leg at the angle of 20° and in both legs at the angle of 70° in the exercise group improved significantly. Furthermore, the strength of the knee flexor muscles in the exercise group was increased. The amount of bilateral strength asymmetry in the knee flexor and extensor muscles at the angle of 70° significantly decreased in the exercise group. Discussions & conclusionsThese data suggest that suspension training is a practical approach to manage bilateral asymmetry in knee flexor and extensor muscle strength in patients with an EDSS of less than four.

Toxicity profiles of immune checkpoint inhibitors in nervous system cancer: a comprehensive disproportionality analysis using FDA adverse event reporting system

Background: Immune-related adverse events (irAEs) always occur during treatment with immune checkpoint inhibitors (ICIs). Patients with nervous system cancer (NSC) may gain clinical benefit from ICIs, but irAEs in NSC patients are rarely examined. Therefore, our study systematically summarized reports of irAEs in NSC. Methods: We obtained information from the FDA adverse event reporting system from the first quarter (Q1) of 2013 to the fourth quarter (Q4) of 2022. We examined use of a combination of ICIs and chemotherapy (ICI_Chemo) or chemotherapy only (ICI_Chemo) for patients with NSC. Multiple disproportionality analyses were applied to assess irAEs. Multiomics data from the gene expression omnibus (GEO) database were analyzed to explore potential molecular mechanisms associated with irAEs in NSC patients. Results: Fourteen irAEs were identified in 8,357 NSC patients after removing duplicates; the top five events were seizure, confused state, encephalopathy, muscular weakness and gait disturbance. Older patients were more likely to develop irAEs than were younger patients. From the start of ICIs_Chemo to irAE occurrence, there was a significant difference in the time to onset of irAEs between age groups. irAEs may occur via mechanisms involving the inflammatory response, secretion of inflammatory mediators, and aberrant activation of pathologic pathways. Conclusions: This study helps to characterize irAEs in NSC patients treated with ICIs. We combined GEO database analysis to explore the potential molecular mechanisms of irAEs. The results of this study provide a basis for improving the toxic effects of ICIs in NSC patients.

Thalamic-limbic circuit dysfunction and white matter topological alteration in Parkinson's disease are correlated with gait disturbance.

Limbic structures have recently garnered increased attention in Parkinson's disease (PD) research. This study aims to explore changes at the whole-brain level in the structural network, specifically the white matter fibres connecting the thalamus and limbic system, and their correlation with the clinical characteristics of patients with PD. Between December 2020 and November 2021, we prospectively enrolled 42 patients with PD and healthy controls at the movement disorder centre. All participants underwent diffusion tensor imaging (DTI), 3D T1-weighted imaging (3D-T1WI), and routine brain magnetic resonance imaging on a 3.0 T MR scanner. We employed the tract-based spatial statistical (TBSS) analytic approach, examined structural network properties, and conducted probabilistic fibre tractography to identify alterations in white matter pathways and the topological organisation associated with PD. In patients with PD, significant changes were observed in the fibrous tracts of the prefrontal lobe, corpus callosum, and thalamus. Notably, the fibrous tracts in the prefrontal lobe and corpus callosum showed a moderate negative correlation with the Freezing of Gait Questionnaire (FOG-Q) scores (r = -0.423, p = 0.011). The hippocampus and orbitofrontal gyrus exhibited more fibre bundle parameter changes than other limbic structures. The mean streamline length between the thalamus and the orbitofrontal gyrus demonstrated a moderate negative correlation with Movement Disorder Society Unified Parkinson's Disease Rating Scale (MDS-UPDRS) III (r = -0.435, p = 0.006). Topological parameters, including characteristic path length (L p), global efficiency (E g), normalised shortest path length (λ) and nodal local efficiency (N le), correlated moderately with the MDS-UPDRS, HAMA, MoCA, PDQ-39, and FOG-Q, respectively. DTI is a valuable tool for detecting changes in water molecule dispersion and the topological structure of the brain in patients with PD. The thalamus may play a significant role in the gait abnormalities observed in PD.

Patterns of cortical thickness alterations in degenerative cervical myelopathy: associations with dexterity and gait dysfunctions.

Degenerative cervical myelopathy (DCM) can lead to significant brain structural reorganization. The association between the cortical changes and specific motor symptoms in DCM has yet to be fully elucidated. We investigated the associations between cortical thickness changes with neurological symptoms, such as dexterity and gait abnormalities, in patients with DCM in a case-control study. A 3 Tesla MRI scanner was used to acquire high-resolution T1-weighted structural scans from 30 right-handed patients with DCM and 22 age-matched healthy controls. Pronounced cortical thinning was observed in DCM patients relative to healthy controls, particularly in the bilateral precentral and prefrontal gyri, left pars triangularis, left postcentral gyrus, right transverse temporal and visual cortices (P ≤ 0.04). Notably, cortical thickness in these regions showed strong correlations with objective motor deficits (P < 0.0001). Specifically, the prefrontal cortex, premotor area and supplementary motor area exhibited significant thickness reductions correlating with diminished dexterity (R2 = 0.33, P < 0.0007; R2 = 0.34, P = 0.005, respectively). Similarly, declines in gait function were associated with reduced cortical thickness in the visual motor and frontal eye field cortices (R2 = 0.39, P = 0.029, R2 = 0.33, P = 0.04, respectively). Interestingly, only the contralateral precuneus thickness was associated with the overall modified Japanese Orthopaedic Association (mJOA) scores (R2 = 0.29, P = 0.003). However, the upper extremity subscore of mJOA indicated an association with the visual cortex and the anterior prefrontal (R2 = 0.48, P = 0.002, R2 = 0.33, P = 0.0034, respectively). In conclusion, our findings reveal patterns of cortical changes correlating with motor deficits, highlighting the significance of combining objective clinical and brain imaging assessments for understanding motor network dysfunction in DCM.

Efficacy of subthalamic deep brain stimulation programming strategies for gait disorders in Parkinson's disease: a systematic review and meta-analysis.

Patients with advanced Parkinson's disease often suffer from severe gait and balance problems, impacting quality of live and persisting despite optimization of standard therapies. The aim of this review was to systematically review the efficacy of STN-DBS programming techniques in alleviating gait disturbances in patients with advanced PD. Searches were conducted in PubMed, Embase, and Lilacs databases, covering studies published until May 2024. The review identified 36 articles that explored five distinct STN-DBS techniques aimed at addressing gait and postural instability in Parkinson's patients: low-frequency stimulation, ventral STN stimulation for simultaneous substantia nigra activation, interleaving, asymmetric stimulation and a short pulse width study. Among these, 21 articles were included in the meta-analysis, which revealed significant heterogeneity among studies. Notably, low-frequency STN-DBS demonstrated positive outcomes in total UPDRS-III score and FOG-Q, especially when combined with dopaminergic therapy. The most favorable results were found for low-frequency STN stimulation. The descriptive analysis suggests that unconventional stimulation approaches may be viable for gait problems in patients who do not respond to standard therapies.

Early detection of Alzheimer's disease using the MEMORIES mnemonic

AbstractThe rising incidence and death rates linked to Alzheimer's disease (AD) highlight an urgent issue. Genetic screening is celebrated as a significant advancement for its early detection capabilities, pinpointing those at risk before the emergence of symptoms. Yet, the limited availability of these technologies highlights a critical gap in widespread application. This review pivots to the potential of presymptomatic clinical assessments as a readily available, economical, and simple strategy for early detection. Traditionally, AD diagnosis relies on the late‐stage identification of cognitive deterioration, functional impairments, and neuropsychiatric symptoms, coinciding with advanced brain degeneration. Conversely, emerging research identifies early indicators preceding significant degeneration, manifesting years before clinical symptoms. We introduce a mnemonic, MEMORIES, to categorize these prodromal: Metabolism changes, Eye/visual impairments, March (refer to gait disturbances), Olfactory dysfunction, Rhythm (blood pressure and heart rate), Insensitivity of the tongue, Ears (hearing loss), and Stool alterations. Recognizing these prodromal through clinical examinations provides a valuable strategy for initiating preventative actions against brain degeneration. This approach advocates for broadening the screening lens beyond genetic screening to encompass clinical evaluations, enhancing early detection and intervention opportunities for AD.