Moderate Parkinson's Disease Research Articles

Movement Disorders

The term movement disorders encompasses a wide range of conditions that cause abnormal movements. This review discusses hypokinetic movement disorders, including bradykinesia, akinesia, akinetic rigid syndrome, and Parkinsonism, an akinetic rigid syndrome that is one of the most common of all the movement disorders which is most often a manifestation of Parkinson disease (PD). The review looks at the epidemiology, etiology, pathology, diagnosis, treatment, and management of PD. Other parkinsonian syndromes include progressive supranuclear palsy, corticobasal syndrome, multiple system atrophy, vascular parkinsonism, normal pressure hydrocephalus, drug-induced parkinsonism, and dementia associated with Parkinson disease. Hyperkinetic movement disorders include tremor, dystonia, tics, myoclonus, and chorea. They include Huntington disease, Wilson disease, tardive dyskinesia, Tourette syndrome, and essential tremor. Figures in this review include examples of generalized dystonia, moderate parkinson disease, affected handwriting, Kayser-Fleischer ring, cervical dystonia, head deviation, and writer's cramp. Tables provide clinical definitions, clues to drug-induced parkinsonism, and a list of drugs that can cause parkinsonism. This review contains 129 references.

Intra- and inter-rater reliability and validity of a clinical and quantifying test of the sit-to-stand task in Parkinsonian syndromes

Measuring sit-to-stand (STS) in Parkinson's disease is an important part of the clinical exam, that both reflects Parkinsonian symptom severity and everyday life abilities. However, there is no quantified, specific, reliable measure that can be applied to all patients and tests their maximal performance. The present study aims to evaluate the intra- and inter-rater reliability and validity of Sit-To-Stand-15 (STS15) that measures the maximal number of sit-to-stand movements performed in 15 seconds. Thirty participants with moderate Parkinson's disease (Hoehn and Yahr 2–3) performed, in the levodopa OFF-state, STS15 with 3 independent raters, on 2 occasions, 1 week apart; raters had to count the number of full sit-to-stand movements completed in 15 seconds. STS15 tests were separated by periods of 15 minutes of rest; the rotation order of the raters was randomized for each patient. Participants were also assessed by MDS-UPDRS part II and III, the 20-meter ambulation test (AT20), the Five Time Sit-To-Stand (FTSTS), the MoCA and the PDQ-8. Intra- and inter-rater reliability were assessed using intraclass correlation coefficients (ICC) and concurrent validity was assessed by Spearman's and Pearson's correlations. Preliminary findings show excellent intra- and inter-rater reliability of STS15, with mean ICC > 0.95. Correlations with FTSTS and AT20, were highly significant and present to a lesser degree with the MDS-UPDRS-III score. The other correlations were not significant. The mean duration of the sit-to-stand movement with STS15 was lower than with FTSTS ( P < 0.01). STS15 is a reliable and valid test to assess sit-to-stand in moderate Parkinson's disease.

Implementation of the HiBalance training program for Parkinson's disease in clinical settings: A feasibility study.

BackgroundTranslating evidence into practice requires adaptation to facilitate the implementation of efficacious interventions. A novel highly challenging balance training program (HiBalance) was found to improve gait, balance, and physical activity in persons with Parkinson’s disease (PD) in an earlier randomized controlled trial. This study aimed to describe the adaptation process and feasibility of implementing the HiBalance program for PD within primary healthcare settings.MethodFeasibility was assessed in terms of study processes and scientific evaluation. Nine persons with mild–moderate PD were enrolled in this pre–post feasibility study. The dose of the original program was adapted by reducing therapist‐led training sessions from three to two times weekly. Outcome measures were substituted with ones more clinically feasible. One group (n = 5) received HiBalance training three times weekly for 10 weeks while another (n = 4) trained twice weekly plus a once weekly home exercise program (HEP). Balance performance was the primary outcome, while secondary outcomes (e.g., gait speed, physical activity level, concerns of falling, and health‐related quality of life) were also evaluated.ResultsRegarding process feasibility, attendance was high (approximately 90%) in both groups, and experiences of the group and home training were positive. Newly selected outcome measures were feasible. The scientific evaluation revealed few adverse events and no serious injuries occurred. Concerning outcomes per group, the average change in balance performance and gait speed was equal to, or exceeded, the minimally worthwhile treatment effect commonly used in PD.ConclusionThe findings support the feasibility, in terms of process and scientific evaluation, of the adapted HiBalance program for implementation within clinical settings. A sufficiently powered study is required to ascertain whether the newly proposed program offers similar short and long‐term effects as the original program.

Safety and Tolerability of Multiple Ascending Doses of PRX002/RG7935, an Anti–α-Synuclein Monoclonal Antibody, in Patients With Parkinson Disease

Aggregated α-synuclein is believed to be central to the pathogenesis of Parkinson disease (PD). PRX002/RG7935 (PRX002) is a humanized monoclonal antibody designed to target aggregated forms of α-synuclein, thereby inhibiting neuron-to-neuron transfer of presumed pathogenic forms of α-synuclein, potentially resulting in neuronal protection and slowing disease progression. To evaluate the safety and tolerability of multiple intravenous infusions of PRX002 in patients with idiopathic PD. Multicenter, randomized, double-blind, placebo-controlled, multiple ascending-dose trial at 8 US study centers from July 2014 to September 2016. Eligible participants were aged 40 to 80 years with mild to moderate idiopathic PD (Hoehn and Yahr stages 1-3). Participants were enrolled into 6 ascending-dose cohorts and randomly assigned to receive PRX002 (0.3 mg/kg, 1.0 mg/kg, 3.0 mg/kg, 10 mg/kg, 30 mg/kg, or 60 mg/kg) or placebo. Participants received 3 intravenous infusions every 4 weeks of PRX002 or placebo and were monitored during a 24-week observational period. Safety and tolerability assessments included physical and neurological examinations, laboratory tests, vital signs, and adverse events. Pharmacokinetic parameters included maximum PRX002 concentration, area under the curve, and half-life. Of the 80 participants, most were white (97.5%; n = 78) and male (80%; n = 64); median (SD) age was 58 (8.4) years. PRX002 was generally safe and well tolerated; no serious or severe PRX002-related treatment-emergent adverse events (TEAEs) were reported. The TEAEs experienced by at least 5% of patients receiving PRX002, irrespective of relatedness to study drug, were constipation (9.1%; n = 5), infusion reaction (7.3%; n = 4), diarrhea (5.5%; n = 3), headache (5.5%; n = 3), peripheral edema (5.5%; n = 3), post-lumbar puncture syndrome (5.5%; n = 3), and upper respiratory tract infection (5.5%; n = 3). No antidrug antibodies were detected. Serum PRX002 levels increased in an approximately dose-proportional manner; mean terminal elimination half-life was similar across all doses (10.2 days). Rapid dose- and time-dependent mean reductions from baseline vs placebo in free serum α-synuclein levels of up to 97% were seen after a single infusion at the highest dose (F78,284 = 1.66; P = .002), with similar reductions after 2 additional infusions. Mean cerebrospinal fluid PRX002 concentration increased with PRX002 dose and was approximately 0.3% relative to serum across all dose cohorts. Single and multiple doses of PRX002 were generally safe and well tolerated and resulted in robust binding of peripheral α-synuclein and dose-dependent increases of PRX002 in cerebrospinal fluid, reaching cerebrospinal fluid concentrations that may be expected to engage extracellular aggregated α-synuclein in the brain. Findings support the design of an ongoing phase 2 clinical study (NCT03100149). ClinicalTrials.gov Identifier: NCT02157714.

MH4 - Examining Parkinson’s Disease Psychosis Treatment Outcomes in the Real World: The Insyte Observational Study

Despite the prevalence of Parkinson’s disease psychosis (PDP), estimated at up to 50% of patients with Parkinson’s disease (PD), little is known regarding the treatment paradigm. The goal of the INSYTE Study – Management of Parkinson’s Disease Psychosis in Actual Practice – is to gain a better understanding of the management of PDP and treatment outcomes. INSYTE is an ongoing study expected to enroll up to 750 patients and their caregivers from approximately 100 sites; patients are followed for 36 months. INSYTE employs validated assessment instruments, although as an observational study does not impose a pre-defined visit schedule, medical tests, laboratory tests, procedures, or interventions. Baseline data for 74 patients enrolled to date found that a majority are male (64%), white (96%), and live in a private residence (92%). Average age is 76.4 years (median=75 years). At baseline, 23% had mild/mild to moderate PD, 54% had moderate/moderate to advanced PD, and 23% had advanced PD. Using the Clinical Global Impression Severity Scale, 36% of patients were borderline to mildly mentally ill and 49% were moderately to markedly mentally ill. Most patients, 64%, were diagnosed with PDP about a year prior to study enrollment. Antipsychotic use was reported in 29 (39%) patients, of which 19 used pimavanserin either as monotherapy (n=14; 48%) or in combination with other atypical antipsychotics (n=5; 17%). The second most common antipsychotic used was quetiapine, followed by olanzapine, clozapine and aripiprazole. INSYTE is the first large observational study to evaluate how patients with PDP are treated in the real-world setting, and how these treatments affect patients. Initial results indicate that only 39% of PDP patients reported antipsychotic use at baseline despite their diagnosis. Results from this study will inform the scientific community on best practices and potentially inform PDP treatment guidelines and standards of care

Dual-task interference during gait on irregular terrain in people with Parkinson’s disease

BackgroundGait impairments in people with Parkinson’s disease (PD) are accentuated in dual-task conditions. Most PD studies on dual-task gait have measured only straight line walking and treadmill gait. Gait alterations on irregular terrain are poorly understood. Research questionTo what extent does walking on irregular terrain exacerbate dual-task interference in people with PD, compared to age-matched control participants? MethodsGait data were collected for nine participants with mild to moderate PD and nine healthy age-matched participants on regular and irregular terrains. Gait was tested as a single task and in dual-task conditions with serial 7 subtractions. The spatiotemporal variables (speed, cadence, single limb support, step length and width), kinematic variables (range of motion for hip, knee and ankle joints) and stability variables (trunk range of motion and center of mass acceleration RMS) were compared across conditions. ResultsPeople with PD showed reduced gait speed and cadence and increased mediolateral center of mass acceleration when walking on irregular terrain with dual-tasks. Surface irregularity was associated with increased ankle transverse motion in both groups. Increased hip and knee sagittal motion was observed in the control participants when terrain changed from regular to irregular under dual-task conditions. This was not statistically significant for the PD group. SignificanceDual-task walking on irregular terrain exacerbated the gait deficits, particularly for people with PD. Gait speed, cadence and mediolateral body stability were compromised when people with PD walked on irregular terrain whilst performing dual-tasks. There was an increase in ankle transverse motion in both groups when traversing irregular terrain. This might have been an adaptive strategy, to prevent tripping.

Low-intensity, goal-directed occupational therapy and physiotherapy did not produce clinically meaningful differences in activities for people with mild to moderate Parkinson's Disease.

Summary of Clarke, C., Patel, S., Ives,N., Rick, C., Dowling, F., Woolley, R., Wheatley, K., Walker, M. & Sackley, C. & the PD REHAB Collaborative Group (2016). Physiotherapy and occupational therapy vs no therapy in mild to moderate Parkinson disease. A randomized clinical trial. JAMA Neurology, 73(3), 291–299.

Microsoft Kinect-based differences in lower limb kinematics during modified timed up and go test phases between men with and without Parkinson’s disease

The aim of the study was to analyse with Microsoft Kinect (Kinect) the differences in lower limb kinematics during sub-phases of modified Timed Up and Go test (modTUG) in men with Parkinson’s disease (PD) compared to healthy age-matched male individuals. Eight men with mild-to-moderate PD (age 67.5±4.5 yrs) and eight healthy men (age 69.8±8.0 yrs) participated. Kinect along with KinectPsyManager (v1.0) and Matlab2016b software was used for data collection. Selected lower limb kinematics and gait speed (GS) were calculated during sittingto- walking (STW) transition while performing modTUG. According to Kinect men with mild to moderate PD did not differ from healthy counterparts in aspects of postural characteristics of STW, with the exception of smaller distance between knees while sitting (p&lt;0.001). Men with PD were found to perform the walking phase of STW transition slower (p&lt;0.01) and with slower GS (p&lt;0.01) comparing to healthy men. In conclusion, compared to healthy men, Kinect detects smaller distance between knees during sitting before transitioning from STW in men with mild to moderate PD. In addition, men with PD also demonstrated slower GS and a longer walking phase of STW transition in comparison to healthy men.

Diabetes mellitus accelerates the onset of levodopa-related motor complications and leads to lower MoCA scores in patients with mild to moderate Parkinsons disease

Recent evidence suggests that diabetes mellitus (DM) may increase the risk of developing Parkinson’s disease (PD) and predisposes to more severe cognitive disturbances amongst PD patients. However, the effects of DM on levodopa-induced motor complications and other non-motor complications are not well studied.

Balance and fear of falling in subjects with Parkinson’s disease is improved after exercises with motor complexity

Resistance training with instability (RTI) uses exercises with high motor complexity that impose high postural control and cognitive demands that may be important for improving postural instability and fear of falling in subjects with Parkinson’s disease (PD). Here, we hypothesized that: 1) RTI will be more effective than resistance training (RT) in improving balance (Balance Evaluation Systems Test [BESTest] and overall stability index [Biodex Balance System®]) and fear of falling (Falls Efficacy Scale-International [FES-I] score) of subjects with Parkinson’s disease (PD); and 2) changes in BESTest and FES-I after RTI will be associated with changes in cognitive function (Montreal Cognitive Assessment [MoCA] score – previously published) induced by RTI. Thirty-nine subjects with moderate PD were randomly assigned to a nonexercising control, RT, and RTI groups. While RT and RTI groups performed progressive RT twice a week for 12 weeks, the RTI group added progressive unstable devices to increase motor complexity of the resistance exercises. There were significant group × time interactions for BESTest, overall stability index, and FES-I scores (P < 0.05). Only RTI improved BESTest, overall stability index and FES-I scores, and RTI was more effective than RT in improving biomechanical constraints and stability in gait (BESTest sections) at post-training (P < 0.05). There were strong correlations between relative changes in BESTest and MoCA (r = 0.72, P = 0.005), and FES-I and MoCA (r = −0.75, P = 0.003) after RTI. Due to the increased motor complexity in RTI, RTI is recommended for improving balance and fear of falling, which are associated with improvement in cognitive function of PD.

Continuous subcutaneous apomorphine infusion does not impair the dynamics of cognitive action control in mild to moderate Parkinson's disease.

Continuous subcutaneous apomorphine infusion (CSAI) is increasingly used in Parkinson's disease (PD), notably in patients contraindicated for subthalamic deep brain stimulation. Although it has been suggested that CSAI is safe regarding cognition, few studies have actually investigated its effect, especially on cognitive control which is a crucial process for goal-directed behavior. More specifically, its impact on the dynamics of cognitive action control, as reflected by the activation and suppression of impulsive responses, has yet to be investigated, which is the objective of the present study. We compared cognitive action control between baseline (M0) and 6months (M6) after the start of add-on CSAI by administering an oculomotor Simon task to 20 patients with mild to moderate PD. We used the activation-suppression model to determine whether CSAI had an effect on either the impulsive errors made in conflict situations or the suppression of these responses. We found no difference between M0 and M6 in the congruence effect regarding either reaction time or accuracy, indicating that overall conflict resolution was not influenced by CSAI. Furthermore, the rate of fast errors in the conflict situation and the last slope of the delta plots (reflecting the strength of impulsive response suppression) were unaffected by the treatment. The 95% confidence intervals calculated for the treatment effect on both of these measures fell below the range of usual meaningful effects. We found no difference between M0 and M6, which strongly suggests that CSAI does not impair the dynamics of cognitive action control.

Encoding strategy training and self-reported everyday prospective memory in people with Parkinson disease: a randomized-controlled trial

ObjectiveTo compare the effects of laboratory-based training in implementation intentions (II; experimental strategy) and verbal rehearsal (VR; control strategy) on self-reported everyday prospective memory among people with Parkinson disease (PD) and to investigate potential correlates of change in self-reported everyday prospective memory in response to this training.MethodThis was a randomized-controlled trial. Participants with mild to moderate PD without dementia underwent one session of training in either II (n = 25) or VR (n = 27). Then they were instructed to use their strategy as much as possible in their everyday lives to help them remember to do things. The Prospective and Retrospective Memory Questionnaire Prospective Scale (PRMQ-Pro) administered at baseline and one month after training assessed training-related change in self-reported everyday prospective memory. Baseline depressive symptoms, perceptions of the strategy (credibility, expectancy), prospective memory-related awareness, global cognition, and disease severity were correlated to PRMQ-Pro Change scores (post minus pre) to determine their association with response to training.ResultsThe VR group’s PRMQ-Pro scores declined from pre to post training, while the II group’s remained stable (p = .03). This effect was driven by change in self-cued everyday prospective memory tasks. Higher baseline depressive symptoms, treatment expectancy, and global cognition related to better response to training in the II group (rs ≤ −.40, ps ≤ .05).ConclusionsII training may prevent everyday prospective memory decline among people with PD. In addition, people with higher depression, stronger expectations of improvement from strategy training, or better global cognition may benefit the most from II training.

The effectiveness of rehabilitation with stimulation after STN-DBS in moderate Parkinson's disease patients

Background: Deep brain stimulation of the subthalamic nucleus (STN-DBS) is a surgical treatment to reduce off-state motor symptoms of Parkinson's disease (PD). Although several studies have shown the postoperative effect of STN-DBS on postural instability, the effectiveness of postoperative rehabilitation is still uncertain.

High-Speed Resistance Training Modifies Load-Velocity and Load-Power Relationships in Parkinson's Disease.

Muscle power is a major neuromuscular factor affecting motor function and independence in patients with Parkinson's disease (PD), and it is commonly targeted using high-speed exercise. This study examined the changes in velocities (Vpp) and percent loads (%1RMpp) at peak power and load-velocity (L-V) and load-power (L-P) relationships, resulting from resistance training because of exercise choice and loading in older patients with PD. Fourteen older adults with mild to moderate PD participated in a 12-week randomized controlled power training trial. Changes in L-V and L-P relationships for the biceps curl, chest press, leg press, hip abduction, and seated calf were assessed using pneumatic resistance machines at loads ranging from 30 through 90% of subjects' 1 repetition maximum for each exercise. Significant increases in Vpp were seen for biceps curl, leg press, hip abduction, and seated calf and decreases in %1RMpp were noted for biceps curl and hip abduction. Additionally, unique patterns of change were seen in these relationships across exercises, with biceps curl, chest press, and leg press showing the greatest shifts at the lower load end of the loading spectrum, and hip abduction and seated calf showing greatest responses at the higher end. The patterns of change in L-V and L-P relationships provide evidence for the unique responses of the specific muscle groups and joints to the exercises evaluated and offer a framework for more exacting exercise prescriptions in patients with PD.

The relation of anxiety and cognition in Parkinson's disease.

Parkinson's disease (PD) has long been conceptualized as a motor disorder, but nonmotor symptoms also manifest in the disease and significantly reduce quality of life. Anxiety and cognitive dysfunction are prevalent nonmotor symptoms, even in early disease stages, but the relation between these symptoms remains poorly understood. We examined self-reported anxiety and neurocognitive function, indexed by measures of executive function (set-shifting and phonemic fluency), categorical fluency, and attention/working memory. We hypothesized that anxiety would correlate with cognitive performance. The Beck Anxiety Inventory and cognitive tests (Trail Making, Verbal Fluency, Digit Span) were administered to 77 nondemented adults with mild to moderate idiopathic PD (39 men, 38 women; Mage = 62.9 years). Higher anxiety was associated with more advanced disease stage and severity and with poorer set-shifting when using a derived metric to account for motoric slowing. Depression correlated with greater anxiety and disease severity, but not with cognitive performance. Our findings support the association of anxiety with a specific domain of executive function, set-shifting, in nondemented individuals with mild to moderate PD, raising the possibility that treatment of anxiety may alleviate aspects of executive dysfunction in this population. (PsycINFO Database Record

Effects of intensive physical therapy on levodopa prescription in Parkinson's disease over a 5-month period

There is a growing body of evidence in phenotypic animal models of Parkinson's disease (PD) for neuroprotective and even neurorestorative effects of intensive and prolonged aerobic treatment. It has also been suggested that intensity of physical therapy in PD may lead prescribing physicians to reduce daily levodopa doses. We evaluated changes in levodopa prescription after an eight-week, protocol-defined, standardized, physiotherapy regimen that included the teaching of exercises to promote further guided self-practice. Thirty-eight patients with mild to moderate PD (Hoehn & Yahr 2–3) followed a standardized protocol of intensive home PT, three hours/week for eight weeks, with either conventional physical therapy (CPT) or an asymmetric motor strengthening (AMS) program. The study investigator was asked not to interfere with the levodopa prescription during the trial and the prescribing physician was unaware of the hypothesis. We collected the prescribed levodopa-equivalent daily doses (mg/d) at D1 and D150 (3 months after the end of the 8-week program). For 31 patients for whom the levodopa-equivalent daily dose (LED) was available at D150, the LED was 588 ± 426 mg/d at D1 and 529 ± 370 mg/d at D150 (–10%; P = 0.26, t -test). When comparing the two groups, there was no significant difference in dose reduction: 17.5% reduction in the CPT group vs. 2.7% reduction in the AMS group ( P = 0.4). In this sample of patients with mild to moderate PD followed up 3 months after the end of an 8-week intensive PT program, there was a non-significant 10% reduction of the prescribed levodopa dose three months after the end of the PT program. No significant difference in dose reduction was observed between the two PT programs.

Generating Arm-Swing Trajectories in Real-Time Using a Data-Driven Model for Gait Rehabilitation With Self-Selected Speed.

Gait rehabilitation is often focused on the legs and overlooks the role of the upper limbs. However, a variety of studies have demonstrated the importance of proper arm swing both during healthy walking and during rehabilitation. In this paper, we describe a method for generating proper arm-swing trajectories in real time using only measurements of the angular velocity of a person's thighs, to be used during gait rehabilitation with self-selected walking speed. A data-driven linear time-invariant transfer function is developed, using frequency-response methods, which captures the frequency-dependent magnitude and phase relationship between the thighs' angular velocities and the arm angles (measured at the shoulder, in the sagittal plane), using a data set of 30 healthy adult subjects. We show that the proposed method generates smooth trajectories for both healthy individuals and patients with mild to moderate Parkinson disease. The proposed method can be used in future robotic devices that integrate arm swing in gait rehabilitation of patients with walking impairments to improve the efficacy of their rehabilitation.

Exenatide once weekly versus placebo in Parkinson's disease: a randomised, double-blind, placebo-controlled trial

Exenatide, a glucagon-like peptide-1 (GLP-1) receptor agonist, has neuroprotective effects in preclinical models of Parkinson's disease. We investigated whether these effects would be apparent in a clinical trial. In this single-centre, randomised, double-blind, placebo-controlled trial, patients with moderate Parkinson's disease were randomly assigned (1:1) to receive subcutaneous injections of exenatide 2 mg or placebo once weekly for 48 weeks in addition to their regular medication, followed by a 12-week washout period. Eligible patients were aged 25-75 years, had idiopathic Parkinson's disease as measured by Queen Square Brain Bank criteria, were on dopaminergic treatment with wearing-off effects, and were at Hoehn and Yahr stage 2·5 or less when on treatment. Randomisation was by web-based randomisation with a two strata block design according to disease severity. Patients and investigators were masked to treatment allocation. The primary outcome was the adjusted difference in the Movement Disorders Society Unified Parkinson's Disease Rating Scale (MDS-UPDRS) motor subscale (part 3) in the practically defined off-medication state at 60 weeks. All efficacy analyses were based on a modified intention-to-treat principle, which included all patients who completed any post-randomisation follow-up assessments. The study is registered at ClinicalTrials.gov (NCT01971242) and is completed. Between June 18, 2014, and March 13, 2015, 62 patients were enrolled and randomly assigned, 32 to exenatide and 30 to placebo. Our primary analysis included 31 patients in the exenatide group and 29 patients in the placebo group. At 60 weeks, off-medication scores on part 3 of the MDS-UPDRS had improved by 1·0 points (95% CI -2·6 to 0·7) in the exenatide group and worsened by 2·1 points (-0·6 to 4·8) in the placebo group, an adjusted mean difference of -3·5 points (-6·7 to -0·3; p=0·0318). Injection site reactions and gastrointestinal symptoms were common adverse events in both groups. Six serious adverse events occurred in the exenatide group and two in the placebo group, although none in either group were judged to be related to the study interventions. Exenatide had positive effects on practically defined off-medication motor scores in Parkinson's disease, which were sustained beyond the period of exposure. Whether exenatide affects the underlying disease pathophysiology or simply induces long-lasting symptomatic effects is uncertain. Exenatide represents a major new avenue for investigation in Parkinson's disease, and effects on everyday symptoms should be examined in longer-term trials. Michael J Fox Foundation for Parkinson's Research.

Resistance Training Improves Sleep Quality in Subjects With Moderate Parkinson's Disease.

Silva-Batista, C, de Brito, LC, Corcos, DM, Roschel, H, de Mello, MT, Piemonte, MEP, Tricoli, V, and Ugrinowitsch, C. Resistance training improves sleep quality in subjects with moderate Parkinson's disease. J Strength Cond Res 31(8): 2270-2277, 2017-The objectives of this study were to test if 12 weeks of progressive resistance training (RT) improves sleep quality and muscle strength in subjects with moderate Parkinson's disease (PD) and if sleep quality values of subjects with moderate PD are closer to those of age-matched healthy controls (HC) at posttraining. This was a randomized controlled trial conducted between March 2013 and September 2014. Twenty-two subjects with moderate PD were randomly assigned to a nonexercising control group (n = 11) or an RT group (n = 11). Thirty-one HC were not randomized to any group. The RT group performed a RT program twice a week for 12 weeks, whereas the control group made no change to their weekly routine. For subjects with PD, sleep quality (i.e., Pittsburgh Sleep Quality Index [PSQI]) and knee-extensor peak torque were assessed before and after 12 weeks of intervention; for HC, these outcomes were assessed at pretest only. There were differences between RT and control groups in PSQI scores, PSQI subscores(i.e., subjective sleep quality and daytime dysfunction), and knee-extensor peak torque at posttraining (p ≤ 0.05). After RT, the average subjects with PD showed lower (i.e., improved) PSQI scores than the average HC (p ≤ 0.05). A negative association was observed between changes in PSQI scores and changes in knee-extensor peak torque at posttraining (r = -0.58, p = 0.028). No adverse events were reported. The RT is recommended as an adjunct therapeutic method for improving sleep quality of subjects with moderate PD and moving these levels to those observed in HC.

Postural motor learning in Parkinson’s disease: The effect of practice on continuous compensatory postural regulation

IntroductionAlthough balance training is considered the most effective treatment for balance impairments in Parkinson’s disease (PD), few studies have examined if learning for balance control remains intact with PD. This study aimed to determine if learning for automatic postural responses is preserved in people with PD. MethodsEleven participants with moderate PD (68±6.4years; H&Y: 2–3) on their usual medication maintained balance on a platform that oscillated forward and backward with variable amplitude and constant frequency. Participants completed 42 trials during one training session, and retention and transfer tests following a 24-h delay. Performance was measured by comparing spatial and temporal measures of whole-body centre of mass (COM) with platform displacements. Learning was compared between participants with PD and previously reported, age-matched older adults (Van Ooteghem et al., 2010). ResultsAlthough postural responses in participants with PD were impaired compared to control participants, a majority of PD participants improved their postural responses with practice as revealed by reduced COM displacements and improved phase relationships between COM and platform motion. Rates of improvement were comparable between groups demonstrating preserved adaptive capacity for participants with PD. Similar to control participants, the PD group moved toward anticipatory COM control as a strategy for improving stability, exhibited short-term retention of performance improvements, and demonstrated generalizability of the learned responses. Rate of improvement with practice, but not retention, was related to severity of motor impairments. ConclusionsPatients with moderate PD on medication demonstrate retention of improvements in automatic postural responses with practice suggesting that intrinsic postural motor learning is preserved in this group.