Movement Disorder Society-Unified Parkinson's Disease Rating Scale Research Articles

Mild behavioral impairment in idiopathic REM sleep behavior disorder and Lewy body disease continuum.

To investigate the clinical impact of mild behavioral impairment (MBI) in a predefined cohort with Lewy body disease (LBD) continuum. Eighty-four patients in the LBD continuum participated in this study, including 35 patients with video-polysomnography-confirmed idiopathic REM sleep behavior disorder (iRBD) and 49 clinically established LBD. Evaluations included the Movement Disorder Society-Unified Parkinson's Disease Rating Scale (MDS-UPDRS), neuropsychological tests, and MBI Checklist (MBI-C). We examined the clinical associates of MBI-C and its diagnostic values in predicting disease severity and cognitive impairment across the LBD continuum. Participants were classified into 19 cognitively normal (CN), 45 mild cognitive impairment (MCI), and 20 dementia groups. Median MBI-C total scores were 1.0, 8.0, and 18.5 for CN, MCI, and dementia groups, respectively, with a significant increasing trend (p < 0.001). The MBI-C total score demonstrated significant correlations with the MDS-UPDRS part 1 (r = 0.504, p < 0.001) and total scores (r = 0.508, p < 0.001). Furthermore, significant correlations were observed between MBI-C and cognitive performances in frontal/executive (DSC: r = -0.314, p = 0.006; TMT-B: r = -0.338, p = 0.003) and attentional (TMT-A: r = -0.343, p = 0.002) domains. A cutoff 5.0 effectively differentiated the MCI from CN groups (area under the curve (AUC = 0.74). Furthermore, the MBI-C effectively discriminated the iRBD patients with high phenoconversion risk against those with low-risk (cut-off 4.0, AUC = 0.72). The MBI-C may be a useful screening questionnaire reflecting clinical severity across the LBD continuum. Longitudinal studies are needed to determine its value in monitoring disease progression in prodromal LBD.

Longitudinal Serotonergic and Dopaminergic Binding: Impact on Parkinson's Disease Progression and Levodopa Dyskinesia.

We investigated the relationship between serotonergic and dopaminergic specific binding transporter ratios (SBRs) over 4years in Parkinson's disease (PD) patients. We assessed serotonergic innervation's potential compensatory role for dopaminergic denervation, association with PD symptoms, and involvement in the development of levodopa-induced dyskinesia (LID). SBRs of the midbrain and striatum were evaluated from [I-123] N-ω-fluoropropyl-2β-carbomethoxy-3β-(4-iodophenyl)nortropane SPECT images at baseline and after 4years. Correlations between SBRs and PD symptoms were analyzed, alongside interval changes. Study included 177 PD patients (110 males, 67 females; mean age 61.0±9.0years). Significant worsening was observed in Hoehn and Yahr staging and Movement Disorder Society-Unified Parkinson's Disease Rating Scale (MDS-UPDRS) Part II and III scores over 4years (p<0.05, p<0.001, and p<0.001, respectively). SBRs of the caudate, putamen, and midbrain declined significantly (p<0.001). Midbrain and striatal SBRs correlated significantly at both baseline and 4-year follow-up (p<0.0001). Striatal SBRs correlated significantly with MDS-UPDRS II and III scores at both time points, while midbrain SBRs correlated with changes in MDS-UPDRS III scores over the 4years (p<0.01). Putamen and midbrain SBRs at 4years were significantly lower in patients who developed LID compared to those who did not (p<0.05). The study demonstrates correlations between midbrain and putamen SBRs and MDS-UPDRS scores over 4years in PD patients. Midbrain serotonin dysfunction may contribute to the development of LID.

Cerebrospinal fluid tau and disease progression in early Parkinson's disease: an 8-year longitudinal study.

To explore whether CSF phosphorylated tau-181 (P-tau181) and total tau (T-tau) are associated with disease progression in early PD patients. We analyzed 8-year longitudinal clinical data from 368 early, drug-naive PD patients and 185 matched controls from the Parkinson's Progression Markers Initiative cohort. CSF P-tau181 and T-tau were measured over 5years, while CSF α-synuclein was measured over 3years. Dopamine transporter (DAT) imaging was performed at baseline and at 1, 2, and 4years. PD patients exhibited significantly lower CSF P-tau181, T-tau and P-tau181/T-tau ratio than controls at each visit. Higher baseline CSF P-tau181 predicted greater increases in Movement Disorder Society Unified Parkinson's Disease Rating Scale (MDS-UPDRS) III (estimate: 0.067, P < 0.001) and Montreal Cognitive Assessment (MoCA) scores (estimate: -0.010, P = 0.009). Similarly, higher baseline CSF T-tau predicted greater increases in MDS-UPDRS III (estimate: 0.005, P < 0.001) and MoCA scores (estimate: -0.001, P = 0.013). Higher baseline P-tau181/T-tau ratio predicted greater increases in MDS-UPDRS III (estimate: 0.552, P < 0.001) but was not significantly associated with changes in MoCA scores (estimate: -0.052, P = 0.114). CSF P-tau181 (estimate = 84.889, P < 0.001), T-tau (estimate = 8.297, P < 0.001) and P-tau181/T-tau ratio (estimate = 263.425, P < 0.001) were positively correlated with CSF α-synuclein but not correlated with striatal DAT uptake. Elevated baseline CSF P-tau181, T-tau and P-tau181/T-tau ratio in early PD patients predict accelerated motor deterioration, with P-tau181 and T-tau also predicting cognitive decline, potentially through interactions with α-synuclein. However, the direct role of tau on nigrostriatal dopaminergic degeneration remains uncertain.

Computer model for gait assessments in Parkinson's patients using a fuzzy inference model and inertial sensors.

Patients with Parkinson's disease (PD) in the moderate and severe stages can present several walk alterations. They can show slow movements and difficulty initiating, varying, or interrupting their gait; freezing; short steps; speed changes; shuffling; little arm swing; and festinating gait. The Movement Disorder Society-Unified Parkinson's Disease Rating Scale (MDS-UPDRS) has a good reputation for uniformly evaluating motor and non-motor aspects of PD. However, the motor clinical assessment depends on visual observations, the results are qualitative, and subtle differences are not identified. This study presents a fuzzy inference model for gait assessments in PD patients with detailed descriptions of signal processing and eight biomechanical indicators computations; as such, other authors can replicate the presented methods. The computer model uses 334 bilateral measurements of 58 Parkinson's patients and 15 healthy control subjects performed over one year. The computer model validations are based on physician evaluations in real-time and post-analysis using an extensive database of videos and signals. The assessment results are explainable, quantitative, and qualitative, increasing their acceptance and use in clinical environments. The computer system design considers three expert motor evaluations, including the PD patients' evolutions; this facilitates correlation with medication doses and appropriate intervals for follow-up medical consultations. The assessments include three qualitative gait conditions of MDS-UPDRS-normal, slight, and mild-as well as a numerical evaluation of up to two decimal places.

Kirigami-Inspired Stretchable Piezoelectret Sensor for Analysis and Assessment of Parkinson's Tremor.

Human muscle activity contains rich information that can reflect human movement patterns and conditions of diseases or physical abnormalities. Flexible pressure sensors enable the assessment of muscle tremors in Parkinson's disease (PD) through Force Myography (FMG). Here, an easily fabricated, ultra-sensitive, and stretchable piezoelectret pressure sensor is presented. Utilizing an effective integration of Kirigami structure and piezoelectret air gap, the sensor achieved a dynamic sensitivity of ≈725 pC/N (@5Hz), measurement repeatability of <2.5%, measurement hysteresis of <1%, a pressure detection limit of <15Pa, a response time of ≈2.5ms, stable output within ±3% over 40000 cycles, and output decay of <2.5% after 1000 cycles of complex deformation, meeting non-distorted measurement conditions up to 20Hz. Successful monitoring and assessment of hand muscle tremors are demonstrated. Furthermore, using a 1×3 sensor array enabled tremor localization, achieving a high accuracy rate of 99.5% with machine learning algorithms. Additionally, the sensor facilitated the experimental quantification and assisted scoring of the Movement Disorder Society Unified Parkinson's Disease Rating Scale (MDS-UPDRS), with an accuracy of ≈85%. The sensor demonstrates potential for assisting in the diagnosis and rehabilitation monitoring of Parkinson's disease.

Phase 1 study of safety and preliminary efficacy of intranasal transplantation of human neural stem cells (ANGE-S003) in Parkinson’s disease

BackgroundIntranasal transplantation of ANGE-S003 human neural stem cells showed therapeutic effects and were safe in preclinical models of Parkinson’s disease (PD). We investigated the safety and tolerability of this treatment...

Biomechanics of Parkinson’s Disease with Systems Based on Expert Knowledge and Machine Learning: A Scoping Review

Patients with Parkinson’s disease (PD) can present several biomechanical alterations, such as tremors, rigidity, bradykinesia, postural instability, and gait alterations. The Movement Disorder Society–Unified Parkinson’s Disease Rating Scale (MDS-UPDRS) has a good reputation for uniformly evaluating motor and non-motor aspects of PD. However, motor clinical assessment depends on visual observations, which are mostly qualitative, with subtle differences not recognized. Many works have examined evaluations and analyses of these biomechanical alterations. However, there are no reviews on this topic. This paper presents a scoping review of computer models based on expert knowledge and machine learning (ML). The eligibility criteria and sources of evidence are represented by papers in journals indexed in the Journal Citation Report (JCR), and this paper analyzes the data, methods, results, and application opportunities in clinical environments or as support for new research. Finally, we analyze the results’ explainability and the acceptance of such systems as tools to help physicians, both now and in future contributions. Many researchers have addressed PD biomechanics by using explainable artificial intelligence or combining several analysis models to provide explainable and transparent results, considering possible biases and precision and creating trust and security when using the models.

Evaluating efficacy and safety of Saffron add-on treatment in improvement of motor and depressive symptoms of patients with Parkinson’s disease: A randomized, double-blind, placebo-controlled clinical trial

AimEvidence has highlighted neuroprotective effects of saffron in animal models of Parkinson’s disease (PD). The present study investigated the efficacy and safety of add-on saffron on motor and depressive symptoms of patients with PD. MethodsThis study was an 8-week, randomized, double-blind, and parallel-group clinical trial. Known cases of PD with depression were randomized to receive either a routine treatment (levodopa or levodopa-equivalent dose of a dopamine agonist) plus saffron capsule (15 mg bid) or routine treatment plus placebo. All participants were assessed using the Hamilton Depression Rating Scale (HAMD), Geriatric Depression Scale-30 (GDS-30), item 3 of Movement Disorder Society Unified Parkinson's Disease Rating Scale (MDS-UPDRS) part 1, MDS-UPDRS part 3, and H and Y scale at baseline and at week 8. ResultsA total of 52 patients (25 in saffron and 27 in placebo groups) were included. Our results demonstrated that saffron could not improve motor symptoms of PD patients (F=0.53, df=1, p=0.424). However, repeated-measures analysis showed a significant effect of time × treatment (F=8.24, df=1, p=0.006) on HAMD scores, indicating a greater improvement of depressive symptoms in saffron compared to placebo groups. Our study showed nonsignificant findings regarding the secondary outcome measures (GDS-30, item 3 of MDS-UPDRS part 1, and H and Y scale). We showed that treatment with saffron is safe in PD. ConclusionWe substantiated that add-on treatment with saffron significantly improved depression, but not motor symptoms, in PD. Further trials with larger sample sizes and longer follow-ups are needed to confirm our findings.

A single-blind, randomised control trial on the effectiveness of a structured multi component training module for family caregiver of persons with Parkinson's disease: A study protocol.

Parkinson disease (PD), a neurodegenerative disorder that progresses over time, is steadily growing in number and prevalence worldwide. PD in Malaysia is expected to increase five-fold by 2040 from the existing estimate of 20,000 patients in 2018. Treatment program of PD in Malaysia is rather unstructured, and there is no known comprehensive PD family caregiver training program available to date. To ensure the quality of a program, it must be tested for feasibility, effectiveness and sustainability. This paper describes the protocol of a study that evaluates the effectiveness of a structured, comprehensive training program of family caregiver to persons with PD in comparison to usual care. A total of 60 pairs of persons with PD of stage II and III, and their primary family caregiver will be recruited and allocated into either an experimental or a control group for 12 weeks of intervention. The experimental group will undergo initial training from multi-disciplinary healthcare providers and will be given a physical module containing weekly tasks that must be practised at home. While the control group will receive a usual care. Both groups will be assessed in terms of physical functions, functional mobility, quality of life (QoL), caregiver burden and knowledge using standardised assessment tools namely Movement Disorder Society-Unified Parkinson's Disease Rating Scale (MDS-UPDRS), Timed Up and Go (TUG) test, Parkinson's Disease Questionnaire (PDQ-39), European Quality of Life five-dimensions (EQ-5D), Malay version of Zarit Burden Interview (MZBI) and Knowledge of Parkinson Disease Questionnaire (KPDQ). In addition, the feasibility and sustainability of the interventions will be evaluated, alongside its cost-effectiveness based on the average and incremental cost effectiveness ratio. All data will be analysed using descriptive and inferential statistics, particularly mixed model ANOVA. There is a significant gap in the literature pertaining family caregiver training programs for people with PD. Documented programs are lacking in term of comprehensiveness of content, application approach and the measurement of training outcomes including the program cost-effectiveness. The feasibility and effectiveness of such training program in a Malaysian setting also requires investigation due to differences in living environment, support system and population's perception. This study will assist to fulfil the existing literature gap and demonstrate the potential benefit of caregiver involvement in mediating the care and therapy for PD in the home setting. Optimum knowledge and skills gained through the training are expected to enhance the confidence and ability of the family caregivers and may possibly reduce their perceived caregiving burden. The protocol of this study is registered in the Australian-New Zealand Clinical Trial Registry (ANZCTR) with a registration number ACTRN12623000336684.

Validation of computer vision technology for analyzing bradykinesia in outpatient clinic videos of people with Parkinson's disease

BackgroundCurrent diagnosis and monitoring of Parkinson's disease (PD) is based on subjective clinical assessments. Objective measures of motor functioning could support clinical acumen. Computer vision (CV) technology is a promising contactless technique but requires further validation. AimTo investigate the performance of CV analysis of clinic-based videos of finger-tapping. Our goals were (i) to distinguish PD from healthy controls (HC), when compared to human raters, (ii) to measure the severity of bradykinesia, and (iii) detect ON/OFF medication state. MethodsVideos of thirty-one persons with PD and forty-nine HC were collected during clinical outpatient visits. Videos were analysed using CV to produce speed, amplitude, rhythm and composite bradykinesia measures. All videos were independently rated by three raters using the Movement Disorder Society Unified Parkinson's Disease Rating Scale (MDS-UPDRS) and Modified Bradykinesia Rating Scale (MBRS). Twenty video pairs were conducted in ON and OFF states. Classification accuracy for PD/HC state and ON/OFF state were measured using the Area under Receiver Operating characteristic curve and a confusion matrix. CV and clinical measures were correlated using Spearman coefficients. ResultsCV classified disease state with higher accuracy than clinical raters (91 % sensitivity; 97 % specificity). CV measures of bradykinesia correlated significantly with clinical ratings: R = 0.740 for MDS-UPDRS, 0.715 for MBRS speed, 0.714 for amplitude and 0.504 for rhythm. CV classified ON/OFF state as accurately as clinical raters. DiscussionCV can provide a valid, objective and contactless bradykinesia assessment based on clinically collected videos, which offers promise as a new clinical outcome, including in remote settings.

Weak association between total alpha‐synuclein reflex tear levels and non‐motor symptoms burden in Parkinson's disease

AbstractBackgroundAlpha‐synuclein (αSyn) is critical to the pathogenesis of Parkinson's disease (PD). Recognition of non‐motor symptoms as clinical manifestations of PD suggests aggregation of αSyn in extranigral areas.AimThis study aimed to evaluate the association between total αSyn levels in reflex tears with non‐motor symptoms.MethodsThis cross‐sectional study included 25 people living with PD (PwP) and 38 age‐matched healthy controls (HC). Total αSyn reflex tear levels were measured using an enzyme‐linked immunosorbent assay. PwP were evaluated using the Non‐Motor Symptoms Scale (NMSS), the Movement Disorders Society Unified Parkinson's Disease Rating Scale (MDS‐UPDRS), Hoehn and Yahr Stage (HY), and Montreal Cognitive Assessment (MoCA).ResultsTotal αSyn reflex tear levels were significantly higher in PwP when compared with HC (1.77 pg/mL [IQR 1.75–1.79] vs. 1.73 pg/mL [IQR 1.70–1.75], p &lt; 0.001). The urinary domain was negatively correlated with total αSyn levels in tears (r = −0.416, p = 0.048). No correlation was observed between total αSyn levels in reflex tears with MDS‐UPDRS, HY, or MoCA.ConclusionsTotal αSyn levels in reflex tears can differentiate PD from HC. In addition, total αSyn reflex tear levels were associated with the urinary domain of NMSS but are not associated with motor and cognitive symptoms, nor HY. Therefore, our findings suggest that it does not reflect ongoing dopaminergic neurodegeneration.

Safety and efficacy of adipose-derived mesenchymal stem cell therapy in elderly Parkinson's disease patients: an intermediate-size expanded access program

ObjectiveThis intermediate-size expanded access program aimed to evaluate safety and clinical efficacy of multiple intravenous infusions of autologous, Hope Biosciences adipose-derived mesenchymal stem cell (HB-adMSC) therapy in elderly patients with Parkinson's disease (PD). MethodsTen eligible participants (aged 76–95 years) received six intravenous infusions each with 200MM autologous HB-adMSCs over 18 weeks, with the end of study (EOS) at week 26. Safety was assessed through adverse events (AEs) and serious adverse events (SAEs). Efficacy was measured through improvements in both motor and non-motor symptoms, utilizing scales including Movement Disorder Society Unified Parkinson's Disease Rating Scale (MDS-UPDRS) parts I-IV, Parkinson's Disease Questionnaire-39 (PDQ-39), Parkinson's disease Fatigue Scale (PFS-16), Patient Health Questionnaire-9 (PHQ-9), and Visual Analog Scale (VAS). Analysis employed paired t-tests and Minimal Clinically Important Difference (MCID) thresholds for the patient-reported outcomes. ResultsMost AEs (37 out of 46) were mild in severity, with 5 SAEs reported, none attributed to the drug. No deaths occurred. Despite lack of statistical significance across the efficacy endpoints, modest yet clinically meaningful improvements with effect size > 0.3 were observed in several secondary efficacy endpoints (MDS-UPDRS part I & III, PDQ-39, and PHQ-9) at the EOS, nearing or surpassing the established MCID values. ConclusionsThe administration of autologous 200MM HB-adMSCs was found to be safe and well-tolerated in the elderly PD population. Although not achieving statistical significance, modest clinical improvements were noted across multiple secondary endpoints. These findings underscore the safety profile of the treatment in elderly patients and highlight the importance of evaluating clinical relevance alongside statistical measures for meaningful patient outcomes. Further investigation with a larger, randomized, placebo-controlled design is warranted to validate these observations.

In-Home Remote Assessment of the MDS-UPDRS Part III: Multi-Cultural Development and Validation of a Guide for Patients.

The shift toward virtualized care introduces challenges in assessing the motor severity of Parkinson's disease (PD). The Movement Disorder Society Unified Parkinson's Disease Rating Scale (MDS-UPDRS) part III, the most used rating scale in PD, lacks validation for synchronous remote administration. Our goal was to validate the usability of a patient guide to allow an accurate video-based MDS-UDPRS part III remote examination. We conducted a multi-stage mixed methods study that included a team consensus for the concept of the guide, cognitive pretesting, and usability (system usability scale, [SUS]) testing in five sites (total n = 25 participants) with distinct linguistic and cultural contexts. A multi-language (English, Portuguese, Spanish, and traditional Chinese) largely pictograph guide of the MDS-UPDRS part III remote examination reached benchmark for usability (SUS score ≥68) in 25 participants who completed the synchronous remote assessment. The MDS-UDPRS part III remote examination guide can be used remotely accurately, and facilitate clinical practice and research in a paradigm of telemedicine.

Long-Term Dementia Risk in Parkinson Disease.

It is widely cited that dementia occurs in up to 80% of patients with Parkinson disease (PD), but studies reporting such high rates were published over two decades ago, had relatively small samples, and had other limitations. We aimed to determine long-term dementia risk in PD using data from two large, ongoing, prospective, observational studies. Participants from the Parkinson's Progression Markers Initiative (PPMI), a multisite international study, and a long-standing PD research cohort at the University of Pennsylvania (Penn), a single site study at a tertiary movement disorders center, were recruited. PPMI enrolled de novo, untreated PD participants and Penn a convenience cohort from a large clinical center. For PPMI, a cognitive battery is administered annually, and a site investigator makes a cognitive diagnosis. At Penn, a comprehensive cognitive battery is administered either annually or biennially, and a cognitive diagnosis is made by expert consensus. Interval-censored survival curves were fit for time from PD diagnosis to stable dementia diagnosis for each cohort, using cognitive diagnosis of dementia as the primary end point and Montreal Cognitive Assessment (MoCA) score <21 and Movement Disorder Society-Unified Parkinson's Disease Rating Scale (MDS-UPDRS) Part I cognition score ≥3 as secondary end points for PPMI. In addition, estimated dementia probability by PD disease duration was tabulated for each study and end point. For the PPMI cohort, 417 participants with PD (mean age 61.6 years, 65% male) were followed, with an estimated probability of dementia at year 10 disease duration of 9% (site investigator diagnosis), 15% (MoCA), or 12% (MDS-UPDRS Part I cognition). For the Penn cohort, 389 participants with PD (mean age 69.3 years, 67% male) were followed, with 184 participants (47% of cohort) eventually diagnosed with dementia. The interval-censored curve for the Penn cohort had a median time to dementia of 15 years (95% CI 13-15); the estimated probability of dementia was 27% at 10 years of disease duration, 50% at 15 years, and 74% at 20 years. Results from two large, prospective studies suggest that dementia in PD occurs less frequently, or later in the disease course, than previous research studies have reported.

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.

Rest Tremor in Parkinson's Disease Is Associated with Ipsilateral Striatal Dopamine Transporter Binding.

The cardinal motor symptoms of Parkinson's disease (PD) include rigidity, bradykinesia, and rest tremor. Rigidity and bradykinesia correlate with contralateral nigrostriatal degeneration and striatal dopamine deficit, but association between striatal dopamine function and rest tremor has remained unclear. The aim of this study was to investigate the possible link between dopamine function and rest tremor using Parkinson's Progression Markers Initiative dataset, the largest prospective neuroimaging cohort of patients with PD. Clinical, [123I]N-ω-fluoropropyl-2β-carbomethoxy-3β-(4-iodophenyl)nortropane ([123I]FP-CIT) single photon emission computed tomography (SPECT), and structural magnetic resonance imaging data from 354 early PD patients and 166 healthy controls were included in this study. We employed a novel approach allowing nonlinear registration of individual scans accurately to a standard space and voxelwise analyses of the association between motor symptoms and striatal dopamine transporter (DAT) binding. Severity of both rigidity and bradykinesia was negatively associated with contralateral striatal DAT binding (PFWE < 0.05 [FWE, family-wise error corrected]). However, rest tremor amplitude was positively associated with increased ipsilateral DAT binding (PFWE < 0.05). The association between rest tremor and binding remained the same controlling for Hoehn & Yahr stage, Movement Disorder Society Unified Parkinson's Disease Rating Scale (MDS-UPDRS) part III score, bradykinesia-rigidity score, or motor phenotype. The association between rest tremor and binding was independent of bradykinesia-rigidity and replicated using 2-year follow-up data (PFWE < 0.05). In agreement with the existing literature, we did not find a consistent association between rest tremor and contralateral dopamine defect. However, our results demonstrate a link between rest tremor and increased or less decreased ipsilateral DAT binding. Our findings provide novel information about the association between dopaminergic function and parkinsonian rest tremor. © 2024 The Author(s). Movement Disorders published by Wiley Periodicals LLC on behalf of International Parkinson and Movement Disorder Society.

Assessing gait dysfunction severity in Parkinson’s Disease using 2-Stream Spatial-Temporal Neural Network

Parkinson’s Disease (PD), a neurodegenerative disorder, significantly impacts the quality of life for millions of people worldwide. PD primarily impacts dopaminergic neurons in the brain’s substantia nigra, resulting in dopamine deficiency and gait impairments such as bradykinesia and rigidity. Currently, several well-established tools, such as the Movement Disorder Society-Unified Parkinson’s Disease Rating Scale (MDS-UPDRS) and Hoehn and Yahr (H&Y) Scale, are used for evaluating gait dysfunction in PD. While insightful, these methods are subjective, time-consuming, and often ineffective in early-stage diagnosis. Other methods using specialized sensors and equipment to measure movement disorders are cumbersome and expensive, limiting their accessibility. This study introduces a hierarchical approach to evaluating gait dysfunction in PD through videos. The novel 2-Stream Spatial-Temporal Neural Network (2S-STNN) leverages the spatial–temporal features from the skeleton and silhouette streams for PD classification. This approach achieves an accuracy rate of 89% and outperforms other state-of-the-art models. The study also employs saliency values to highlight critical body regions that significantly influence model decisions and are severely affected by the disease. For a more detailed analysis, the study investigates 21 specific gait attributes for a more nuanced quantification of gait disorders. Parameters such as walking pace, step length, and neck forward angle are found to be strongly correlated with PD gait severity categories. This approach offers a comprehensive and convenient solution for PD management in clinical settings, enabling patients to receive a more precise evaluation and monitoring of their gait impairments.

Scale consistance in cognitive status awareness of patients with Parkinson’s disease

Objectives: This study aimed to investigate the relationship between patients’ awareness of their cognitive symptoms and the presence of cognitive involvement according to neuropsychological tests. Patients and methods: In this cross-sectional study, 539 patients (276 males, 263 females; mean age: 64.3±11.0 years; range, 19 to 88 years) were assessed between September 2020 and June 2023. The Mini-Mental Status Examination (MMSE) scores were recorded in addition to age, sex, education level, and chronic diseases. Patients were classified as having cognitive disorders if their MMSE scores were &lt;26, while those with scores ≥26 were classified as cognitively healthy. The relationship between the frequency of cognitive involvement according to a related question from the Movement Disorder Society Unified Parkinson’s Disease Rating Scale (MDS-UPDRS) and the frequency of cognitive disorders according to the MMSE scores was evaluated. Results: No relationship was detected between the frequency of cognitive disorders according to the MMSE scores and the frequency of cognitive involvement according to the corresponding question in the nonmotor component of the MDS-UPDRS (p&lt;0.001). Conclusion: The findings indicate that the cognitive impairment inquiry in the nonmotor section of the MDS-UPDRS is not an effective method for detecting cognitive involvement in Parkinson’s disease.

Long-term outcomes of subthalamic nucleus deep brain stimulation for Parkinson's disease in Singapore.

Subthalamic nucleus deep brain stimulation (STN-DBS) is a proven treatment modality for Parkinson's disease (PD), reducing dyskinesia and time spent in the "OFF" state. This study evaluates the long-term outcomes of STN-DBS in PD patients up to 10 years post-surgery in Singapore. We conducted a retrospective review of Movement Disorders Society-Unified Parkinson's Disease Rating Scale (MDS-UPDRS) scores, activities of daily living (ADLs), disease milestones, dopaminergic drug prescriptions, and adverse events in patients before and after STN-DBS surgery. A total of 94 PD patients who underwent bilateral STN-DBS were included. STN-DBS reduced time in the "OFF" state by 36.9% at 1 year (P=0.034) and 40.9% at 5 years (P=0.006). Time with dyskinesia did not significantly change. Levodopa equivalent daily dose was reduced by 35.1% by 5 years (P<0.001). MDS-UPDRS-II and III scores increased from 5 years post-DBS by 40.5% and 35.4%, respectively. Independence in ADLs decreased, though not significantly. The prevalence of frequent falls increased at 5 years. Surgery- and device-related adverse events were uncommon and generally mild. STN-DBS provides sustained relief from motor complications and reduced medication requirements in PD patients in Singapore. This study highlights STN-DBS as an effective treatment option, significantly enhancing the quality of life for those with PD.

Dual-task performance and brain morphologic characteristics in Parkinson's disease.

Introduction Parkinson's disease (PD) reduces an individual's capacity for automaticity which limits their ability to perform two tasks simultaneously, negatively impacting daily function. Understanding the neural correlates of dual-tasks (DT) may pave the way for targeted therapies. To better understand automaticity in PD, we aimed to explore whether individuals with differing DT performances possessed differences in brain morphologic characteristics. Methods Data were obtained from 34 individuals with PD and 47 healthy older adults including: 1) demographics (age, sex), 2) disease severity (Movement Disorder Society - Unified Parkinson's Disease Rating Scale (MDS-UPDRS), Hoehn &amp; Yahr, levodopa equivalent daily dose (LEDD)), 3) cognition (Montreal Cognitive Assessment), 4) Levodopa Equivalent Daily Dose, 5) single task- and DT- performance during a DT-Timed-Up-and-Go test utilizing a serial-subtraction task, and 6) Cortical thicknesses and subcortical volumes obtained from volumetric MRI. Participants were categorized as low or high DT performers if their combined DT-effect was greater than the previously determined mean value for healthy older adults (μ=74.2). Nonparametric testing using Quade's ANCOVA was conducted to compare cortical thicknesses and brain volumes between the highDT and lowDT groups while controlling for covariates: age, sex, MDS-UPDRS part III, LEDD, and intracranial volume. Secondarily, similar comparisons were made between the healthy older adult group the highDT and lowDT groups. Lastly, a hierarchical linear regression model was conducted regressing combined DT-effect on covariates (block one) and cortical thicknesses (block 2) in stepwise fashion. Results The highDT group had thicker cortices than the lowDT group in the right primary somatosensory (p=0.001), bilateral primary motor (p=&lt;0.001, left; p=0.002, right), bilateral supplementary motor area (p=0.001, left; p&lt;0.001, right), and mean of the bilateral hemispheres (p=0.001, left; p&lt;0.001, right). Of note, left primary cortex thickness (p=0.002), left prefrontal cortex thickness (p&lt;0.001), and right supplementary motor area thickness (p=0.003) differed when adding a healthy comparison group. Additionally, the regression analysis found that the left paracentral lobule thickness explained 20.8% of the variability in combined DT-effect (p=0.011) beyond the influence of covariates. Conclusions These results suggest regions underlying dual-task performance; specifically, a convergence of neural control relying sensorimotor integration, motor planning, and motor activation to achieve higher levels of DT performance for individuals with PD.