Parkinson's Disease Rating Scale-III Research Articles

Multidisciplinary Complex Treatment of Parkinson's disease : Cornerstone of an individualized treatment

The inpatient Parkinson's disease multimodal complex treatment (PD-MCT) was applied more than 15,000 times in 2022, in Germany. This number is increasing as is Parkinson's disease (PD), which affects more than 400,000 people in Germany and leads to 100,000 disability-adjusted life years. In recent years, several observational studies have been conducted on the effectiveness of this kind of multidisciplinary care. To summarize and discuss the evidence on the nature, benefits and potential of PD-MCT. Anarrative review of selected empirical findings was carried out. The PD-MCT frequently lasts for 2-3 weeks and aims to maintain the quality of life of people with PD. Disease symptoms and activities of daily living are jointly improved by pharmacological strategies and activating therapies (physiotherapy, occupational therapy, speech and language therapy, physical training, art therapy). The PD-MCT is auseful measure to avoid or mitigate crisis situations in the course of the disease. A total of eight observational studies (n = 1246) have shown good effectiveness with a total mean improvement of the International Parkinson and Movement Disorder Society unified Parkinson's disease rating scaleIII (MDS-UPDRSIII) by 7.8points. The transfer of effects into everyday life through intensive and specialized community-based care must be ensured in order to achieve sustained effects on the quality of life. Ideally, this transfer can be supported by integrated PD networks and digital technologies in the future. There is potential for development in the standardization, patient selection and quality assurance of PD-MCT as well as in the embedding in care structures such as PD networks. Open research questions include aprecise definition of the target group and higher quality evidence of short-term and long-term effectiveness.

Ocular vestibular-evoked myogenic potential assists in differentiation of multiple system atrophy from Parkinson's disease.

Vestibular-evoked myogenic potentials (VEMPs) can help assess otolithic neural pathway in the brainstem that may also participate in cardiovascular autonomic function. Parkinson's disease (PD) is associated with altered VEMP responses; however, the association between VEMP abnormalities and multiple system atrophy (MSA) remains unknown. Therefore, we compared the extent of otolith dysfunction using ocular (oVEMP) and cervical VEMP (cVEMP) between MSA and PD. We analyzed the clinical features and VEMP and head-up tilt table test (HUT) findings using the Finometer in 24 patients with MSA and 52 with de-novo PD, who had undergone neurotologic evaluation in a referral-based university hospital in South Korea from January 2021 to March 2023. MSA was associated with bilateral oVEMP abnormality (odds ratio [95% confidence interval] = 9.19 [1.77-47.76], p=0.008). n1-p1 amplitude was negatively correlated with Unified Multiple System Atrophy Rating Scale I-II scores in patients with MSA (r=-0.571, p=0.033), whereas it did not correlate with Movement Disorder Society-Unified Parkinson's Disease Rating Scale-III scores in patients with PD (r=-0.051, p=0.687). n1 latency was negatively correlated with maximum changes in systolic blood pressure within 15 s during HUT in patients with PD (r=-0.335, p=0.040) but not in those with MSA (r=0.277, p=0.299). In conclusion, bilaterally abnormal oVEMP responses may indicate the extent of brainstem dysfunction in MSA. oVEMP reflects the integrity of otolith-autonomic interplay, reliably assists in differentiating between MSA and PD, and helps infer clinical decline.

The Feasibility and Efficacy of a Virtual Reality Tandem Cycling Program for Persons with Parkinson's Disease and Their Care Partners.

Persons with Parkinson's disease (PwPD) suffer from motor and non-motor symptoms which significantly affect their quality of life (QoL), and the QoL of their care partners (CP). Tandem cycling reduces PwPD motor symptoms; however, no studies have examined other benefits or included PwPD CP. We conducted an 8-week community virtual reality (VR) tandem cycling intervention to assess the feasibility and efficacy for PwPD and their CP (i.e., PD dyads). We hypothesized that dyadic tandem cycling would improve (1) PwPD motor and non-motor symptoms and (2) dimensions of PD dyads' QoL and physiologic health. Ten PD dyads were recruited to complete 8weeks of progressive intensity, bi-weekly tandem cycling. At pre- and post-testing, PwPD were assessed using the Movement Disorder Society-Unified Parkinson's Disease Rating Scale-III (MDS-UPDRS-III), functional gait assessment (FGA), and 10-m gait speed test. PD dyads also completed emotional and cognitive status questionnaires [e.g., Geriatric Depression Scale-Short Form (GDS-SF)], and wore BodyGuard 2 heart rate (HR) monitors for 48h to assess surrogate measures of heart rate variability. Statistical analyses were conducted using Student's t tests with significance set at p ≤ 0.05. Eight PD dyads and one PwPD completed the intervention. Retention of PwPD (90%) and CP (80%) was adequate, and PD dyad adherence ranged from 91.67 to 97.91%. PwPD demonstrated significant clinical improvements in MDS-UPDRS-III scores (-7.38, p<0.01), FGA scores (+3.50, p<0.01), and 10-m gait speed times (+0.27m/s, p<0.01), in addition to significant self-reported improvements in mobility (-13.61, p=0.02), fatigue (-5.99, p=0.02), and social participation (+4.69, p<0.01). CP depressive symptoms significantly decreased (-0.88, p=0.02), and PD dyads shared a significant increase in root mean square of the successive differences (RMSSD; p=0.04). Our pilot study demonstrated feasibility and multiple areas of efficacy supporting further investigation of community VR tandem cycling as a therapeutic intervention for PD dyads.

Connecting the Dots: Exploring the Relationship between Optical Coherence Tomography and 99mTc-TRODAT-1 SPECT Parameters in Parkinson's Disease.

While optical coherence tomography (OCT) is explored as a potential biomarker in Parkinson's disease (PD), technetium-99m-labeled tropane derivative (99mTc-TRODAT-1) single-photon emission computed tomography (SPECT) imaging has a proven role in diagnosing PD. Our objective was to compare the OCT parameters in PD patients and healthy controls (HCs) and correlate them with 99mTc-TRODAT-1 parameters in PD patients. This cross-sectional study included 30 PD patients and 30 age- and gender-matched HCs. Demographic data, PD details including Movement Disorders Society Unified Parkinson's Disease Rating Scale-III (MDS-UPDRS-III) and Hoehn-Yahr (HY) staging, and OCT parameters including macular and peripapillary retinal nerve fiber layer (RNFL) thickness in bilateral eyes were recorded. PD patients underwent 99mTc-TRODAT-1 SPECT imaging. The terms "ipsilateral" and "contralateral" were used with reference to more severely affected body side in PD patients and compared with corresponding sides in HCs. PD patients showed significant ipsilateral superior parafoveal quadrant (mean ± standard deviation [SD] = 311.10 ± 15.90 vs. 297.57 ± 26.55, P = 0.02) and contralateral average perifoveal (mean ± SD = 278.75 ± 18.97 vs. 269.08 ± 16.91, P = 0.04) thinning compared to HCs. Peripapillary RNFL parameters were comparable between PD patients and HCs. MDS-UPDRS-III score and HY stage were inversely correlated to both ipsilateral (Spearman rho = -0.52, P = 0.003; Spearman rho = -0.47, P = 0.008) and contralateral (Spearman rho = -0.53, P = 0.002; Spearman rho = -0.58, P < 0.001) macular volumes, respectively. PD duration was inversely correlated with ipsilateral temporal parafoveal thickness (ρ = -0.41, P = 0.02). No correlation was observed between OCT and 99mTc-TRODAT-1 SPECT parameters in PD patients. Compared to HCs, a significant thinning was observed in the ipsilateral superior parafoveal quadrant and the contralateral average perifoveal region in PD patients. Macular volume and ipsilateral temporal parafoveal thickness were inversely correlated with disease severity and duration, respectively. OCT and 99mTc-TRODAT-1 SPECT parameters failed to correlate in PD patients.

Preoperative Attention/Memory Problem Affects the Quality of Life of Parkinson's Disease Patients after Deep Brain Stimulation: A Cohort Study.

The aim of this study was to investigate the impact of nonmotor symptoms (NMS) on the quality of life (QoL) outcome after subthalamic nucleus deep brain stimulation (STN-DBS) at the 1-year follow-up. Ninety-three patients diagnosed with Parkinson's disease (PD), who underwent subthalamic nucleus deep brain stimulation (STN-DBS) between April 2020 and August 2021, were included in this study. Demographic information was gathered through a self-designed questionnaire. The severity of both motor and non-motor symptoms, along with the quality of life (QoL), was assessed using the Unified Parkinson's Disease Rating Scale-III (UPDRS-III), Nonmotor Symptoms Scale (NMSS), and 8-item Parkinson's Disease Questionnaire (PDQ-8), respectively. Significant differences were observed in the UPDRS-III score, NMSS summary index (SI), and subscores of six domains (sleep/fatigue, mood/cognition, perceptual problems/hallucinations, attention/memory, urinary, and sexual function) between the baseline and the 6- and 12-month follow-ups. The correlation analysis revealed positive correlations between the preoperative NMSS SI and subscores of seven domains (cardiovascular, sleep/fatigue, mood/cognition, perceptual problems/hallucinations, attention/memory, gastrointestinal, and urinary) and ΔPDQ-8. Moreover, the preoperative PDQ-8 SI (β = 0.869, P < 0.001) and the preoperative attention/memory subscore (β = -0.154, P = 0.026) were predictive of the postsurgery improvement in quality of life (QoL). Deep brain stimulation (DBS) led to an improvement in the patients' nonmotor symptoms (NMS) at the 1-year follow-up, along with a correlation observed between NMS and the patients' quality of life (QoL). Notably, the severity of preoperative attention/memory problems emerged as the most significant predictor of NMS influencing the QoL outcome after STN-DBS at the 1-year follow-up.

Minimal clinically important differences of spatiotemporal gait variables in Parkinson disease

BackgroundAssessment of gait function in People with Parkinson Disease (PwPD) is an important tool for monitoring disease progression in PD. While comprehensive gait analysis has become increasingly popular, only one study, Hass et al. (2014), has established minimal clinically important differences (MCID) for one spatiotemporal variable (velocity) in PwPD. Research QuestionWhat are the MCIDs for velocity and additional spatiotemporal variables, including mean, variability, and asymmetry of step length, time, and width? MethodsAs part of a larger clinic-based initiative, 382 medicated, ambulatory PwPD walked on an instrumented walkway during routine clinical visits. Distribution and anchor-based methods (Unified Parkinson's Disease Rating Scale-III, Modified Hoehn and Yahr, and the mobility subsection of the Parkinson Disease Questionnaire) were used to calculate MCIDs for variables of interest in a cross-sectional approach. ResultsDistribution measures for all variables are presented. Of nine gait variables, four were significantly associated with every anchor and pooled to the following values: velocity (8.2 cm/s), step length mean (3.6 cm), step length variability (0.7%), and step time variability (0.67%). SignificanceThe finalized MCID for velocity (8.2 cm/s) was nearly half of the MCID of 15 cm/s reported by Hass et al., potentially due to differences in calculations. These results allow for evaluations of effectiveness of interventions by providing values that are specific to changes in gait for PwPD. Alterations of methodology including different versions of clinical or walking assessments, and/or different calculation and selection of gait variables necessitate careful reasoning when using presented MCIDs.

The effect of task-oriented circuit training-based telerehabilitation on upper extremity motor functions in patients with Parkinson's disease: A randomized controlled trial

IntroductionUpper extremity functions are impaired in patients with Parkinson's disease (PwPD), which leads to difficulties in activities of daily living (ADL), such as reaching or handwriting. The aim of this study was to investigate the effectiveness of task-oriented circuit training-based telerehabilitation (TOCT-TR) on the upper extremity motor function in PwPD. MethodsIn this randomized controlled trial (RCT) 30 PwPD (aged 45–70 years, Hoehn & Yahr stage I-III) were recruited and randomly allocated into two groups. The TOCT-TR group received home training through video sessions three days/week for six weeks. Additionally, both the TOCT-TR group and the control group (CG) underwent home exercises aimed at improving balance, gait, and mobility three days/week for six weeks. The primary outcome measure was upper extremity motor functions measured with the Nine Hole Peg test (9-HPT), the Jebsen Hand Function Test (JHFT), grip strengths, pinch strengths, and the Unified Parkinson's Disease Rating Scale-III (UPDRS-III). Secondary outcome measures included the UPDRS-II and the quality of life (QoL, PDQ-8). ResultsThis study showed significant group-by-time interactions on the 9-HPT (p < 0.001), the JHFT (p < 0.001), grip strengths (p < 0.001), pinch strengths (p ≤ 0.015), and the UPDRS-III (p = 0.007) in favor of the TOCT-TR. Additionally, the UPDRS-II (p < 0.001), and the PDQ-8 (p = 0.005) improved in both groups. ConclusionThis is the first RCT showing that the TOCT-TR improved upper extremity motor functions, ADL, and QoL in PwPD. The TOCT-TR may help improve the upper extremities of PwPD who have difficulties reaching rehabilitation clinics.

Effectiveness and safety of safinamide in the Toledo Movement Disorders Unit.

The management of motor fluctuations in Parkinson's disease (PD) can be challenging, and current therapeutic options include the use of monoamine oxidase B inhibitors (MAO-B inhibitors), among others. The aim of this study was to evaluate the effectiveness and safety of safinamide in the clinical practice carried out in the Toledo Movement Disorders Unit. This is a retrospective study in which data were collected at baseline and at six months from PD patients who were started on safinamide as an add-on therapy with a stable dose of levodopa in line with standard clinical practice. An analysis was performed by subgroups: patients who were given low-dose safinamide and patients who previously received rasagiline. Ninety patients (47 previously received rasagiline) completed the six-month follow-up. A statistically significant decrease in morning akinesia, nocturnal akinesia, wearing off, unpredictable off phenomenon and Unified Parkinson's Disease Rating Scale-III was observed both in those who previously received rasagiline and in those treated with low doses of safinamide. No variation was found in the dyskinesias. The adverse events described were mild, with generalised weakness, dizziness, nausea, headache and alopecia. Safinamide has been shown to be effective and safe in improving motor fluctuations, motor symptoms and the subjective perception of disease severity in PD patients previously receiving rasagiline and in those receiving low-dose safinamide, all of which is accompanied by a good safety profile.

Vagal cross-sectional area correlates with parasympathetic dysfunction in Parkinson's disease.

The aim of this prospective study was to investigate autonomic function in Parkinson's disease with a multidimensional approach including clinical evaluation tools, head-up tilt test and morphological studies of the vagus nerve. Head-up tilt test parameters including high frequency power of the heart frequency interval, the ratio of low frequency power of the distance between two consecutive R waves in electrocardiogram (RR interval) to the high frequency and low frequency power of systolic blood pressure were used to evaluate parasympathetic, cardiac sympathetic and vasomotor sympathetic functions, respectively, in 80 patients with Parkinson's disease. We examined the cross-sectional area of the vagus nerves bilaterally using nerve ultrasound and compared mean values with a control group of healthy subjects (n = 40) as well as patients with chronic inflammatory demyelinating polyneuropathy (n = 76). The cross-sectional area of right/left vagus nerve of Parkinson's patients was significantly lower compared to the right/left vagus nerve of the control group and of chronic demyelinating polyneuropathy patients. Furthermore, the cross-sectional area of the right vagus nerve was significantly larger from the one of the left vagus nerve for all groups. Based on tilt test, 43 patients (disease duration 7 ± 5, age at evaluation 71 ± 9, Hoehn and Yahr score 2.8 ± 8) were diagnosed with autonomic dysfunction (orthostatic hypertension n = 11, chronotropic incompetence n = 31, postural orthostatic tachycardia syndrome n = 1). Patients with orthostatic hypotension showed significantly higher Unified Parkinson's Disease Rating Scale-III values than those with chronotropic incompetence. The cross-sectional area of the vagus nerve correlated inversely with heart rate in rest and supine position and positively with tilt test parameters representing parasympathetic modulation through vagal activity [high frequency power of the distance between two consecutive R waves in electrocardiogram (RR interval)] at rest. We demonstrate for the first time that morphological characteristics of the vagus nerve correlate with parameters of parasympathetic function from the spectral analysis of cardiovascular parameters in tilt test for Parkinson's patients. This correlation reveals the impact of the atrophy of vagal atrophy for autonomic function in Parkinson's disease. Nerve ultrasound of the vagus nerve could potentially be used as an adjunct to tilt table examination to diagnose autonomic dysfunction.

Neuropsychological, neuropsychiatric, and clinical correlates of affective and cognitive theory of mind in Parkinson's disease: A meta-analysis.

Theory of mind (ToM) is the ability to infer others' mental (Cognitive) and emotional (Affective) states, both being impaired in Parkinson's disease (PD). However, the clinical, neuropsychological, and neuropsychiatric features underlying Affective and Cognitive ToM deficits in PD are unclear. Therefore, we performed a meta-analytic study to test whether PD demographical, clinical, neuropsychological, or neuropsychiatric changes related differently to both ToM processes. A systematic literature search was performed up to January 2022, including a total of 31 studies following our search terms. Data from each study were obtained from demographic (age, education), clinical (disease duration, Hoehn & Yahr staging system, Unified Parkinson's Disease Rating Scale-III, levodopa equivalent daily dose), neuropsychological (global cognitive functioning, memory subdomains, executive functions subdomains, processing speed/complex attention/working memory, visuospatial and constructional abilities, and language), and neuropsychiatric (depression, apathy, anxiety) variables. Affective ToM impairment in PD was related to lower educational level and global cognition, deficits of generativity, decision making, attention/working memory, and language. Conversely, Cognitive ToM deficits were associated with advanced age, poorer global cognition, executive dysfunctions, and language impairments. Medication moderated the relationship between attention/working memory and Cognitive ToM, whereas age moderated the association of Affective ToM with language. No significant associations were found between ToM deficits and patients' neuropsychiatric or clinical states. These findings clarify the neuropsychological and clinical features that explain ToM deficits in PD. Possibly, our results suggest the need to explore the complex neural networks involving frontostriatal and temporoparietal circuits behind changes in social cognition in PD. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Patients with Parkinson's disease and a history of falls have decreased cerebellar grey matter volumes in the cognitive cerebellum

The objective of this study was to determine if cerebellar gray matter (GM) structure differs between fallers and non-fallers with Parkinson's disease (PD) and their respective association to cognitive function. A total of 48 fallers and 63 non-fallers with PD were identified from the Parkinson's Progression Markers Initiative database. Fallers were categorized as those who self-reported a fall within the past year. Unified Parkinson's Disease Rating Scale-III (UPDRS-III), Montreal Cognitive Assessment (MoCA), Trail Making Test parts A (TMT-A) and B (TMT-B) scores were collected for each patient. Cerebellar GM volumes were derived from magnetic resonance imaging data. Analyses of covariance were used to compare group differences. Partial Pearson's correlations were used to assess the relationship between cerebellar GM volumes to UPDRS-III and cognitive outcomes. Significance was set at P ≤ 0.01. Fallers had significantly decreased GM volumes in lobules V, Crus-1, Crus-2, and VIIb (P<0.01). Cerebellar GM volumes in non-fallers demonstrated little-to-no relationship with UPDRS-III, MoCA, and TMT-B (P>0.01). However, TMT-A performance demonstrated significant, fair association to GM volumes in lobules I–IV, V, VI, Crus-1, and Crus-2 (r=−0.44 – −0.34, P<0.01) in non-fallers. Patients with PD and a history of falls have significantly decreased GM volumes in cerebellar lobules associated with cognitive functions. However, these lobule volumes become disassociated with cognitive function compared to non-fallers.

A Clinical Study of Patients with Primary Parkinson's Disease Undergoing Bilateral Deep Brain Stimulation (STN-DBS) Surgery in the Subthalamic Nucleus under General Anesthesia

To assess the efficacy and safety of bilateral subthalamic nucleus deep brain stimulation (STN-DBS) under general anesthesia and to provide the basis for clinical research related to DBS surgeries under general anesthesia. A total of 60 patients with primary Parkinson's disease who underwent DBS surgery between January 2019 and December 2021at West China Hospital were enrolled for the study. Among them, 30 had the surgery while they were asleep, i.e., under general anesthesia, and 30, while they were awake, i.e., under local anesthesia. All the patients underwent bilateral STN-DBS surgery. Bispectral index (BIS) was used to monitor and control the depth of anesthesia. Microelectrode recording (MER) technology was used to record the characteristic signals of the bilateral subthalamic nuclei and verify their location during the operation. All patients completed the implantation of deep electrodes, connecting wires, and implantable stimulation generator (IPG) at one time. Postoperative thin-slice CT scans were done to reconstruct electrode images and to verify the accuracy of electrode implantation. The Unified Parkinson's Disease Rating Scale-Ⅲ (UPDRS-Ⅲ) was used to evaluate the preoperative vs. postoperative improvement in motor symptoms, and the results of intraoperative MER and the occurrence of surgery-related complications were documented and analyzed. All patients successfully completed the implantation surgery. The electrodes were accurately implanted at the right position and there was no significant difference between the general anesthesia group and the local anesthesia group in UPDRS-Ⅲ scores and medication dosage differences before and after the operation. No intracranial hemorrhage, cerebral infarction, or infection occurred after the operation, and 5 patients had temporary mental and behavioral abnormalities, which disappeared within 48 hours after the operation. The postoperative therapeutic effect of STN-DBS surgery for primary Parkinson's disease under general anesthesia is comparable to that of the traditional STN-DBS surgery under local anesthesia. When the operation is performed under general anesthesia, the incidence of surgery and anesthesia-related complications is low if patients are managed strictly, and patients would also experience improved surgical comfort.

Subthalamic and pallidal stimulation in Parkinson's disease induce distinct brain topological reconstruction

The subthalamic nucleus (STN) and globus pallidus internus (GPi) are the two most common and effective target brain areas for deep brain stimulation (DBS) treatment of advanced Parkinson's disease. Although DBS has been shown to restore functional neural circuits of this disorder, the changes in topological organization associated with active DBS of each target remain unknown. To investigate this, we acquired resting-state functional magnetic resonance imaging (fMRI) data from 34 medication-free patients with Parkinson's disease that had DBS electrodes implanted in either the subthalamic nucleus or internal globus pallidus (n = 17 each), in both ON and OFF DBS states. Sixteen age-matched healthy individuals were used as a control group. We evaluated the regional information processing capacity and transmission efficiency of brain networks with and without stimulation, and recorded how stimulation restructured the brain network topology of patients with Parkinson's disease. For both targets, the variation of local efficiency in motor brain regions was significantly correlated (p < 0.05) with improvement rate of the Uniform Parkinson's Disease Rating Scale-III scores, with comparable improvements in motor function for the two targets. However, non-motor brain regions showed changes in topological organization during active stimulation that were target-specific. Namely, targeting the STN decreased the information transmission of association, limbic and paralimbic regions, including the inferior frontal gyrus angle, insula, temporal pole, superior occipital gyri, and posterior cingulate, as evidenced by the simultaneous decrease of clustering coefficient and local efficiency. GPi-DBS had a similar effect on the caudate and lenticular nuclei, but enhanced information transmission in the cingulate gyrus. These effects were not present in the DBS-OFF state for GPi-DBS, but persisted for STN-DBS. Our results demonstrate that DBS to the STN and GPi induce distinct brain network topology reconstruction patterns, providing innovative theoretical evidence for deciphering the mechanism through which DBS affects disparate targets in the human brain.

Association between sleep disturbances and pain subtypes in Parkinson's disease.

To explore the influence of sleep disturbances on the various pain subtypes experienced by patients with Parkinson's disease (PD). A cohort of eighty-eight patients with PD-related pain was recruited for this study. Their demographic and clinical features, including age, disease duration, levodopa equivalent daily dose (LEDD), and scores on the Unified Parkinson's Disease Rating Scale-III (UPDRS III), Hoehn-Yahr Scale (H&Y), Pittsburgh Sleep Quality Index (PSQI), King's Parkinson's disease Pain Scale (KPPS), visual analog scale (VAS), Mini-Mental State Examination (MMSE), activities of daily living scale (ADL), Hamilton Depression Rating Scale (HAMD), and Hamilton Anxiety Rating Scale (HAMA), were recorded. The prevalence of sleep disorders was 76.1% in patients with PD-related pain. Among these patients, the group of poor sleep had more severe motor symptoms, more anxiety and depression symptoms, lower functional independence, and experienced more pain, such as musculoskeletal pain, chronic pain, fluctuation related pain, nocturnal pain, and discoloration/edema/swelling (p < 0.05). In addition, PSQI scores correlated positively with the scores of all 7 domains in KPPS (p < 0.05). H&Y stage and PSQI were significant independent variables explaining 50.0% of the variance in KPPS scores. Sleep disturbance showed an association with pain in PD patients and may have a greater effect on some certain subtypes of PD-related pain than others.

Factors Contributing to Malnutrition in Parkinson's Disease Patients With Freezing of Gait.

Background and PurposeLittle is known about the nutritional status and clinical characteristics of patients with Parkinson's disease with freezing of gait (PDFOG). The purpose of this study was to describe the relationship between nutritional status and characteristics of patients with PDFOG.MethodsIn this cross-sectional study, 178 PDFOG patients were recruited and classified as nutritionally normal or at risk of malnutrition/already malnourished based on their Mini Nutritional Assessment (MNA) scores. Each participant underwent a structured questionnaire, physical examination and routine serum biochemical tests.ResultsWe found that 44.4 and 37.1% of PDFOG patients were malnourished [mini nutritional assessment (MNA) score <17] and at risk of malnutrition (17 ≤ MNA score ≤ 23.5), respectively. Compared to patients with normal nutrition, PDFOG patients with malnutrition and at risk of malnutrition had longer duration of Parkinson's disease (PD) and freezing of gait (FOG), more levodopa equivalent daily doses (LEDD), lower body mass index (BMI), more motor symptoms according to the Unified PD Rating Scale-III (UPDRS-III) and non-motor symptoms according to the PD Non-motor Symptoms Questionnaire (PD-NMS) (P < 0.05). Uric acid, albumin, prealbumin, and total cholesterol (TC) differed between the two groups (P < 0.05). High Hoehn and Yahr (H-Y) stage, high Freezing of Gait Questionnaire (FOGQ) scores, low TC and low uric acid were risk factors for malnutrition in patients with PDFOG.ConclusionOur results showed disease severity, motor symptoms, TC levels and uric acid levels were all associated with nutritional status in patients with PDFOG. This study suggest early discovery of the nutritional status of PDFOG patients is important.

Pain Assessment in Chinese Parkinson’s Disease Patients Using King’s Parkinson’s Disease Pain Scale

PurposeTo assess Parkinson’s disease (PD)-related pain using the Chinese translation of King’s Parkinson’s disease Pain Scale (KPPS).Patients and MethodsA cohort of 200 patients with primary PD was recruited for this study. Their demographic and clinical features, including age, disease duration, levodopa equivalent daily dose (LEDD), and scores on the Unified Parkinson’s Disease Rating Scale-III (UPDRS III), Hoehn-Yahr Scale (H&Y), Mini-Mental State Examination (MMSE), Activities of Daily Living Scale (ADL), Hamilton Depression Rating Scale (HAMD), Hamilton Anxiety Rating Scale (HAMA), Pittsburgh Sleep Quality Index (PSQI), Visual Analogue Scale (VAS) and KPPS, were recorded.ResultsThe prevalence of PD-related pain was 44.5%. Among the patients with PD-related pain, the average KPPS score was 41.2 ± 26.8. Pain was most commonly located in the lower limbs (60.7%), upper limbs (22.5%) and waist (21.3%). The most common pain type was musculoskeletal pain (68.5%). Compared with the PD group without pain, the PD group with pain had a longer disease duration (p = 0.022), higher LEDD (p = 0.008), higher UPDRSIII score (p = 0.018), higher H&Y stage (p = 0.003), higher HAMD score (p < 0.001), higher HAMA score (p < 0.001), lower ADL score (p = 0.046) and higher PSQI score (p < 0.001). PD-related pain was correlated with the H&Y stage and the PSQI score (p < 0.05). Cut-off points of 0, 34, and 70 were obtained to discriminate pain severity levels between no pain, mild, moderate, and severe pain, respectively.ConclusionChinese version of KPPS is not only an easy tool for characterization and scoring of pain in PD patients but also has the ability to distinguish between different levels of pain severity.

Feasibility of online PD SAFEx™ exercise rehabilitation for symptom improvements of Parkinson's disease: A pilot study.

Parkinson's Disease (PD) is a neurodegenerative disorder affecting both motor and cognitive symptoms. While medications show some improvement in motor symptoms, cognitive symptoms can worsen. In-person exercise programs, such as PD SAFEx™, are an important adjunct therapy in improving symptoms. However, coronavirus disease 2019 (COVID-19) limited in-person exercise interventions. Therefore, there is a need to investigate the effectiveness of online exercise delivery. To identify (1) whether an online exercise intervention can achieve similar results to an identical in-person intervention and (2) if online PD SAFEx™ can alter the cognitive decline of PD patients. 20 participants with idiopathic PD participated in a 12-week online PD SAFEx™ program and were compared to 73 participants from in-person PD SAFEx™. The primary outcome measure was the Unified Parkinson's Disease Rating Scale-III measured before/after intervention. Three secondary cognitive measures were collected with the online group. Main effect of time on UPDRS-III scores of both groups were found (F(1,92) = 35.555, p < 0.001). No interaction was found between in-person and online groups (F(1,1) = 0.052, p = 0.820). TMT B in the online group showed significant improvements in executive function (F(1,17) = 7.095, p = 0.016). Online and in-person PD SAFEx™ both achieved clinically significant UPDRS-III improvement and are statistically equivalent. Online PD SAFEx™ reduced cognitive symptoms seen during COVID-19.

Does visuospatial motion perception correlate with coexisting movement disorders in Parkinson's disease?

Postural instability and balance impairment are common in Parkinson's disease (PD). Multiple factors, such as increased tone, bradykinesia, freezing of gait, posture, axial stiffness, and involuntary appendicular movements, can affect balance. The recent studies found that PD patients have abnormal perception of self-motion in vestibular domain. We asked whether measures of balance function, such as perception of one's motion, correlate with specific movement disorders seen in PD. Moving retinal image or self-motion in space triggers the perception of self-motion. We measured one's linear motion (heading) perception when subjects were moved en bloc using a moving platform (vestibular heading). Similar motion perception was generated in the visual domain (visual heading) by having the subjects view a 3D optical flow with immersive virtual reality goggles. During both tasks, the subjects reported the motion direction in the two-alternative-forced-choice paradigm. The accuracy of perceived motion direction was calculated from the responses fitted to the psychometric function curves to estimate how accurately and precisely the subjects can perceive rightward versus leftward motion (i.e., threshold and slope). Response accuracies and psychometric parameters were correlated with the disease duration, disease severity (total Unified Parkinson's Disease Rating Scale-III, UPDRS-III), and tremor, rigidity, axial, gait/posture components of UPRDS-III. We also correlated heading perception with the number of falls and subjective assessment of balance confidence using the Activities-Specific Balance Component (ABC) Scale. Accuracy, threshold, and sensitivity of vestibular heading perception significantly correlated with the disease duration and severity, particularly the tremor. Correlations were stronger for leftward heading perception in the vestibular domain. The visual heading perception was correlated with ABC Scale, especially with its items concerning optic-flow processing. There was asymmetry in leftward versus rightward vestibular heading perception. The level of asymmetry correlated with the axial component of UPDRS-III. Differences in the clinical parameters that correlate with visual versus vestibular heading perception suggest that two heading perception processes have different mechanistic underpinnings. The correlation of discordance between vestibular and visual heading perception with disease severity and duration suggests that visual function can be utilized for balance rehab in PD patients.

Speech Characteristics of Patients with Parkinson's Disease-Does Dopaminergic Medications Have a Role?

Objective The present study aimed to investigate the effects of dopaminergic medication on voice, speech motor functions, and motor impairment in patients with Parkinson's disease (PD). Materials and Methods Twenty-five individuals (16 males and 9 females) with PD underwent comprehensive assessment of voice, speech, and motor functions in levodopa medication ON and medication OFF conditions. Age- and gender-matched healthy controls were recruited to compare speech and acoustic parameters. Multi-Dimensional Voice Program (MDVP) from Computerized Speech Laboratory (Model: 4500) was utilized for acoustic analysis of voice and the Voice Handicap Index (VHI) for the self-assessment of vocal function. Frenchay Dysarthria Assessment (FDA-2) and Unified Parkinson's Disease Rating Scale-III (UPDRS III) were used to evaluate speech motor and motor functions, respectively. Statistical Analysis The mean and standard deviation were used as descriptive statistics measures. Raw scores were obtained for FDA-2, DRS, VHI, MDVP parameters, and UPDRS-III in either medication condition. The Wilcoxon signed-rank test was performed to determine the statistical significance of the above measures in both genders across the medication conditions. Spearman's rank correlation coefficient was used to determine the relationship between motor speech function and motor impairment and between VHI and MDVP parameters across both medication conditions. The interrater reliability rating was established using Cohen's kappa. Results An improvement in lip and laryngeal functioning was found in the medication ON over medication OFF state in both males and females with PD. A few frequency and amplitude-related measures improved in the medication-ON state over the medication-OFF state. UPDRS-III scores reduced from the OFF state to the ON state, and no change in dysarthria severity or VHI was found in either gender or medication condition. No correlation was found between speech motor function and motor function or between VHI and acoustic parameters of voice in either medication condition. Conclusions Improvement in motor symptoms with levodopa was predominantly observed when compared with the minor improvements in a few aspects of speech motor function and vocal parameters. The results of this study suggest the need for speech therapy as a nonpharmacological treatment method for speech impairments in PD.

Different effects of essential tremor and Parkinsonian tremor on multiscale dynamics of hand tremor

ObjectiveEssential tremor (ET) and Parkinsonian tremor (PT) are often clinically misdiagnosed due to the overlapping characteristics of their hand tremor. We aim to examine if ET and PT influence the multiscale dynamics of hand tremor, as quantified using complexity, differently, and if such complexity metric is of promise to help identify ET from PT. MethodsForty-eight participants with PT and 48 with ET performed two 30-second tests within each of the following conditions: sitting while resting arms or outstretching arms horizontally. The hand tremor was captured by accelerometers secured to the dorsum of each hand. The complexity was quantified using multiscale entropy. ResultsCompared to PT group, ET group had lower complexity of both hands across conditions (F > 34.2, p < 0.001). Lower complexity was associated with longer disease duration (r2 > 0.15, p < 0.009) in both PT and ET, and within PT, greater Unified Parkinson's Disease Rating Scale-III UPDRS-III scores (r2 > 0.18, p < 0.009). Receiver-operating-characteristic curves revealed that the complexity metric can distinguish ET from PT (area-under-the-curve > 0.77, cut-off value = 48 (postural), 49 (resting)), which was confirmed in a separate dataset with ET and PT that were clearly diagnosed in prior work. ConclusionsThe PT and ET have different effects on hand tremor complexity, and this metric is promising to help the identification of ET and PT, which still needs to be confirmed in future studies. SignificanceThe characteristics of multiscale dynamics of the hand tremor, as quantified by complexity, provides novel insights into the different pathophysiology between ET and PT.