Pegboard Scores Research Articles

DNA Methylation of BDNF and RASA2 Genes Is Associated With Cognitive Function in Postmenopausal Women With Breast Cancer.

To determine associations among DNA methylation of brain-derived neurotrophic factor (BDNF) and RAS p21 protein activator 2 (RASA2) genes with processing speed and perceived cognitive function. This was a cross-sectional, secondary analysis of baseline data from a randomized controlled trial, the Exercise Program in Cancer and Cognition Study. Data included M values for DNA methylation of the BDNF and RASA2 genes; processing speed, objectively measured using the Grooved Pegboard and Digit Vigilance Test scores; and perceived cognitive function, self-reported using the Patient Assessment of Own Functioning Inventory. Regression analysis was conducted. Greater methylation of cg21291635 of the BDNF gene (p = 0.01) and cg20247102 of the RASA2 gene (p = 0.013) were associated with poorer processing speed, whereas greater methylation of cg20108357 of the BDNF gene (p < 0.001) and cg00567892 of the RASA2 gene (p = 0.019) were associated with better perceived cognitive function. Gene methylation variations were demonstrated, suggesting the genes' potential roles and two possible distinct mechanisms of cognitive function in cancer.&nbsp.

Effects of Cognitive‐motor Rhythmic Training on Executive Functions and Motor Performance in Older Adults with Mild Cognitive Impairment: A Randomized Controlled Trial

AbstractIntroductionIn recent years, prevalence of mild cognitive impairment (MCI) has increased in older adults, exacerbating the potential impact on global health. Cognitive‐motor training is an emerging treatment modality with proven benefits in enhancing both physical and cognitive functions. In recent research findings, training of musical rhythmic skills with auditory‐motor synchronization is beneficial to reactivate the brain’s sensorimotor and perceptual regions as well as to improve cognition. However, there is limited research on combining these modalities.ObjectivesThis pilot study aims to develop a pioneer program on cognitive‐motor rhythmic training (CMRT), and to investigate whether the program would improve the executive functions (EF) and hand functions of patients with MCI.MethodologyThirty patients recruited from the Hong Kong Buddhist Hospital were randomized into two groups: (i) an intervention group receiving a 6‐week training program and (ii) a waitlist control group. The program was designed with reference to the rhythm game “Taiko no Tatsujin”, in which precise timed motor responses were required to hit the circular cues against the target zone. The game was designed with progression of difficulty levels and instant feedback. Classical Cantopop songs that were familiar to Hong Kong older adults were selected. Mental flexibility, inhibitory control, working memory, visuospatial memory, verbal fluency, processing speed and problem‐solving were assessed using domain‐specific cognitive tests, while hand dexterity was measured by the Purdue Pegboard Test. Paired t‐test and ANOVA were used to examine the within group difference and the comparison between groups. The level of significance was set at P&lt;0.05.ResultsThe analysis showed significant Time x Group interaction effects in Color Trail Test (p = 0.001), Color Word Stroop Test (P = 0.002), Digit Span Test (P&lt;0.001), Corsi Block‐Tapping Test (P&lt;0.001), Verbal Fluency Test (P&lt;0.001), Symbol Digit Modalities Test (P = 0.015), Maze Test (P&lt;0.001) and the Purdue Pegboard scores (P&lt;0.001) compared to the control group after training.ConclusionsThe 6‐week CMRT program is effective in improving the executive functions and motor performance in patients with MCI. This innovation can serve as an affordable and quality intervention in early stages of cognitive decline.

57 Clinical Utility of Neuropsychological Evaluation in the Differential Diagnosis Between Late-Onset Primary Progressive Aphasia Semantic Variant (PPA-SV) Versus Limbic Predominant Age-Related TDP-43 Encephalopathy (LATE): A Case Report

Objective:Primary progressive aphasia semantic variant (PPA-SV) is an atypical dementia subtype on the frontotemporal dementia (FTD) spectrum. PPA-SV is clinically defined by naming and semantic deficits, with progressive language decline that generalizes to other domains over time. Typically, it presents as an early-onset dementia with TDP-43 pathology, but 33-46% of PPA-SV cases display initial onset after age 65 with potentially different clinical features. Limbic Predominant Age-Related TDP-43 Encephalopathy (LATE), a more recently discovered neurodegenerative entity, is defined by an older age of onset, hippocampal sclerosis/atrophy, and TDP-43 pathology with a gradually progressive amnestic profile that expands to other cognitive deficits over time. The authors present a case report with overlapping features and suspected TDP-43 neuropathology ante-mortem for two reasons: first, to highlight the need for clinical criteria to formally diagnose LATE, and second, to address a gap in the literature on the possible clinical differences of late-onset PPA-SV.Participants and Methods:The authors present a case of a 78-year-old Indian bilingual man (English dominant) with 18 years of education, noncontributory medical history, and gradually progressive cognitive complaints reported over the past few years who was seen for outpatient neuropsychological evaluation. Prior workup was notable for negative amyloid PET scan, negative p-tau 217 blood test, and abnormal brain MRI revealing marked bilateral hippocampal atrophy with ex vacuo ventriculomegaly and minimal cerebrovascular disease. He scored 23/30 on prior MMSE, was diagnosed with amnestic MCI, prescribed Namenda and Exelon, and complained of minor memory and word-finding difficulties with reportedly intact IADLs and no signs of NPH.Results:Neuropsychological testing revealed a profound dysnomia (RBANS Naming raw score = 1/10), and he provided 0 words on two semantic fluency tasks but 15 words on letter fluency. Receptive vocabulary score was also impaired (PPVT-4, &lt;1st %). Memory performance also demonstrated rapid forgetting of information (RBANS List Recall raw = 0/10, Story Recall raw = 0/12) with no benefit to recognition cues (RBANS List Recognition raw = 12/20), but slightly better visual memory recall, albeit still impaired (RBANS Figure Recall raw = 4/20). Grooved pegboard scores were significantly worse with right-hand than left-hand. Irregular word reading (NAART = 16th %ile) was significantly below expectations and thought to reflect more of a surface dyslexia rather than a cultural confounder given that he has lived in the US for over 50 years and his occupational and educational history was completed in English.Conclusions:Results support the clinical utility of neuropsychological evaluation in the differential diagnosis to support a predominant clinical syndrome of PPA-SV despite overlapping features with LATE and suspected TDP-43 pathology. This case report highlights the diagnostic issue with the lack of literature describing the typical clinical progression or suggested diagnostic criteria of LATE. These findings also indicate that late-onset PPA-SV may include greater memory deficits earlier in the course, but this may also be a clinical masquerade that is more reflective of the extent of language deficits. Further research on late-onset manifestations of PPA-SV and LATE consensus clinical guidelines is advised.

Effect of psoriatic arthritis on the strength, proprioception, skill, coordination, and functional condition of the hand.

This study was planned to evaluate the strength, proprioception, skill, coordination, and functional condition of the hand in individuals with psoriatic arthritis and to correlate disease activity with these parameters. Fifty-six individuals (psoriatic arthritis group, n=36; control group, n=20) were included in the study. Evaluations were performed of disease activity with Disease Activity Score 28; grip strength with a dynamometer and pinch strength with pinch gauge dynamometers; joint position sensation with a goniometer; finger skills with a mobile application; and coordination and skill of both hands with the Purdue Pegboard test. The Michigan Hand Outcomes Questionnaire (MHQ) was used for hand functional evaluation. There was a significant difference between the grip and pinch strength of the psoriatic arthritis group and the control group (P<0.05). There was no significant difference between the joint position sense measurements and the mobile application scores between the groups (P>0.05). Purdue Pegboard scores showed a significant difference only in both hands and assembly subsections (P<0.05). With Disease Activity Score 28, significant correlations were found between grip and pinch strength, mobile application scores, Purdue Pegboard all subsections, and left-hand joint position sense average error amount, and between MHQ and grip and pinch strength. This study is the first to show that psoriatic arthritis has a negative effect especially on hand strength; grip strength decreases as disease severity increases and, skill, coordination, and functionality of hand deteriorate.

Hand dexterity assessment in Parkinson’s disease: construct validity of the 9-Hole peg test for the more affected hand

Purpose There is limited understanding of the characteristics and evaluation of more affected hand dexterity loss in Parkinson’s disease. We described 9-Hole Peg Test performance for the more affected hand and examined the construct validity of these pegboard scores in mild to severe Parkinson’s disease. Methods: This observational study analysed baseline data from a cluster-randomised controlled trial. Participants (n = 582) completed the pegboard with their more affected hand, the Patient-Specific Index-Parkinson’s Disease and Self-assessment Parkinson’s Disease Disability Scale. Mean pegboard performance was summarised at each disease stage. To investigate known groups validity, we explored differences in pegboard scores between participants identifying upper limb problems in their ‘top three’ functional limitations, and those prioritising other limitations. Convergent validity investigated correlations between pegboard performance and self-reported hand function. Results Pegboard performance was reduced compared with normative values, and problems with hand activities were reported at each disease stage. Significant differences in pegboard performance between the two functional limitation priority groups (p < 0.05), and moderate correlations between pegboard dexterity and hand function (Self-assessment Parkinson’s Disease Disability Scale) provided evidence for construct validity. Conclusions People with mild to severely disabling Parkinson’s disease have reduced dexterity and problems with hand function. Evidence supported the construct validity of 9-Hole Peg Test more affected hand performance. IMPLICATIONS FOR REHABILITATION People with mild to severely disabling PD experience dexterity loss and problems with hand function. It is important for clinicians to assess dexterity and hand function in people with this movement disorder. Evidence supports the construct validity of 9-Hole Peg Test for measuring more affected hand performance in Parkinson’s disease.

Audiovisual integrative training for augmenting cognitive- motor functions in older adults with mild cognitive impairment

BackgroundPrevious studies indicated that the behavioral performances of older adults could be enhanced by multisensory integration. This pilot study tested the benefits of an audiovisual integrative (AV) training for improving the cognitive and upper limb motor functions in older adults with mild cognitive impairment (MCI).MethodsTwenty participants, according to their MoCA scores, with ten in each of a MCI (mean age = 63.3 years) and healthy older adult group (mean age = 64.7 years), engaged in AV integrative training. They were recruited from the Institute of Active Ageing at the Hong Kong Polytechnic University. The screening was conducted from February to March 2018 and the training program which consisted of three sessions (2 h each) was conducted from 14-28th May 2018. Their executive function, attention and upper limb functions were measured by the Stroop Test and Purdue Pegboard Test respectively.ResultsThe mixed linear model analysis results showed significant Time x Group interaction effects in the time used in the Stroop Test (dots) (p = 0.042) and the Purdue Pegboard scores (non-dominant hand use) (p = 0.025). The MCI group exhibited significantly more improvements in attentional control and non-dominant hand motor functions after the training.ConclusionsThe findings suggest that the AV integrative training has the potential for enhancing the cognitive and motor functions of older adults with MCI. Furthermore, AV integrative training can serve as an alternative non-pharmacological intervention for combating neurodegeneration in older adults.Trial registrationThis study has been retrospectively registered at the Chinese Clinical Trial Registry which is a World Health Organisation approved registry. Trial registration: Current Controlled Trials ChiCTR2000029408, January 29th, 2020.

A pilot study to assess the effectiveness of local application of salbutamol and nitroglycerine for improvement of hand dexterity and comfort in extreme cold climate at high altitude

Background: Reduced manual dexterity and hand comfort affect all people exposed to extreme cold. Ointment nitroglycerine 0.2% (NTG) and ointment salbutamol 0.5% (Sal) applied topically to the extremities could result in increased local blood flow and temperature, improving hand comfort and dexterity in extreme cold. Aim and Objectives: This study was designed to elucidate if the application of NTG or Sal would improve manual dexterity and hand comfort in extreme cold conditions. Materials and Methods: A double-blind, randomized controlled trial was conducted at 3500 m altitude in 105 individuals divided into three equal-sized groups. Group A received NTG, Group B placebo (white soft paraffin), and Group C Sal, for application to the extremities twice daily, for 2 weeks. Hand skin temperatures (Tsk), Pegboard scores, and a Graphic Rating Scale (GRS) for pain were compared before and after the intervention. Adverse effects and user acceptability criteria were recorded. Results: Participants of all three groups showed significant improvement in Tsk, Pegboard scores, and GRS scores postintervention, however none of the parameters were different between groups. The acceptability questionnaire scores were best in the placebo group. Conclusion: Neither NTG nor Sal was superior to placebo for improvement in hand comfort or dexterity, in extreme cold at high altitude.

Construct validity of the 9-Hole Peg Test and Purdue Pegboard Test in people with mild to moderately severe Parkinson’s disease

ObjectivesTo evaluate the construct validity of two dexterity measures, the 9-Hole Peg Test (9HPT) and Purdue Pegboard Test (PPT) in people with Parkinson’s disease (PD). DesignCross-sectional observational study. SettingTesting was conducted at the university or in participants’ homes. ParticipantsThirty community dwelling people with mild to moderately severe PD and no major upper limb comorbidities or cognitive impairments. InterventionsPegboard tests were administered in the ‘on’ and ‘end-of-dose’ phases of participants’ PD medication cycles. Participants rated hand function with two self-report questionnaires – the Manual Ability Measure-36 (MAM-36) and a subset of upper limb items from the MDS-UPDRS. To explore construct validity, we compared ‘on’ phase pegboard scores with normative values for unimpaired men and women and investigated relationships between pegboard scores and hand function questionnaires. ResultsIn the ‘on’ phase, pegboard scores were poorer than normative values. Differences in individual subtest scores ranged between 10 and 41%. Correlations between self-reported hand function and pegboard scores were weak to moderately strong in the ‘on’ phase (r=0.21–0.51), and weak at ‘end-of-dose’ (r=0.13–0.22). Higher correlation coefficients were observed between hand function and PPT subtest scores than with hand function and 9HPT scores. Most participants reported difficulty with daily hand tasks. ConclusionsWe found evidence for construct validity supporting the use of the 9HPT and PPT to evaluate people with mild to moderately severe PD when ‘on’, but not at the ‘end-of-dose’. Results also suggest that the PPT may be more sensitive to PD-related changes in dexterity than the 9HPT.

Pain interference may be an important link between pain severity, impairment, and self-reported disability in participants with wrist/hand pain

Study DesignCross-sectional. IntroductionPain severity, sensory and motor impairment, and psychological (distress and anxiety) and social factors have previously been related to self-reported disability in persons with wrist and hand pain. Purpose of the studyThe purpose of this study to determine the relative contribution of pain severity, measures of impairment (sensory and motor function), psychosocial factors, and pain interference on self-reported disability experienced by persons with heterogeneous orthopedic injuries and conditions of the wrist and hand. MethodsMeasures of disability and pain severity as well as measures of sensory (pressure pain thresholds, joint position sense), motor (grip strength, Purdue pegboard), and cognitive performance (Stroop test) and psychosocial variables related to pain and participation (West Haven-Yale Multidimensional Pain Inventory) were administered to 60 participants with wrist and hand pain. Pearson product correlations controlled for age and sex, and multiple linear regression was performed to determine the relationship between measures of impairment, pain severity, psychosocial variables, and pain interference with self-reported disability assessed with the Disability of Arm, Shoulder and Hand (DASH) questionnaire. ResultsThe best-fitting regression model with DASH scores entered as the dependent variable (F4,50 = 28.8, P < .01) included MPI Pain Interference (β = −0.54), Life Control (β = −0.16), Purdue pegboard scores (β = −0.32), and Stroop test times (β = 0.21). Pain Interference had the strongest correlation with self-reported disability (adjusted R2 = 0.67, P < .01). ConclusionPain interference appears to be an important factor explaining the link between impairment, pain severity, and self-reported disability. Addressing pain interference may be important to improve outcomes in this population.

Long term at-home treatment with transcranial direct current stimulation (tDCS) improves symptoms of cerebellar ataxia: a case report

BackgroundProgressive cerebellar ataxia is a neurodegenerative disorder without effective treatment options that seriously hinders quality of life. Previously, transcranial direct current stimulation (tDCS) has been demonstrated to benefit cerebellar functions (including improved motor control, learning and emotional processing) in healthy individuals and patients with neurological disorders. While tDCS is an emerging therapy, multiple daily sessions are needed for optimal clinical benefit. This case study tests the symptomatic benefit of remotely supervised tDCS (RS-tDCS) for a patient with cerebellar ataxia.MethodsWe report a case of a 71-year-old female patient with progressive cerebellar ataxia, who presented with unsteady gait and balance impairment, treated with tDCS. tDCS was administered using our RS-tDCS protocol and was completed daily in the patient’s home (Monday – Friday) with the help of a trained study technician. tDCS was paired with 20 min of simultaneous cognitive training, followed by 20 min of physical exercises directed by a physical therapist. Stimulation consisted of 20 min of 2.5 mA direct current targeting the cerebellum via an anodal electrode and a cathodal electrode placed over the right shoulder. The patient completed baseline and treatment end visits with neurological, cognitive, and motor (Lafayette Grooved Pegboard Test, 25 ft walk test and Timed Up and Go Test) assessments.ResultsThe patient successfully completed sixty tDCS sessions, 59 of which were administered remotely at the patient’s home with the use of real time supervision as enabled by video conferencing. Mild improvement was observed in the patient’s gait with a 7% improvement in walking speed, which she completed without a walking-aid at treatment end, which was in stark contrast to her baseline assessment. Improvements were also achieved in manual dexterity, with an increase in pegboard scores bilaterally compared to baseline.ConclusionsResults from this case report suggest that consecutively administered tDCS treatments paired with cognitive and physical exercise hold promise for improving balance, gait, and manual dexterity in patients with progressive ataxia. Remotely supervised tDCS provides home access to enable the administration over an extended period. Further controlled study in a large group of those with cerebellar ataxia is needed to replicate these findings.Trial registrationClinicalTrials.gov Identifier: NCT03049969. Registered 10 February 2017- Retrospectively registered.

The Impact of Paratonia on Fine and Gross Motor Function in Older Adults With Mild and Moderate Dementia.

Dementia is associated with impairment in gait, balance, and fine motor function. Paratonia, a form of hypertonia, is often present in severe dementia. However, little is known about muscle tone in early dementia, and the eventual relation between muscle tone abnormalities and changes in fine and gross motor function. Three groups of participants were included in the study: healthy controls (n=60), participants with mild dementia (MiD) (n=31), and participants with moderate dementia (n=31). Measurements of fine motricity (Purdue pegboard test), balance and gait (Dynaport Hybrid), the presence of paratonia (PAI), and muscle tone measurements (MyotonPRO) were performed. Paratonia was present in 42% of participants with MiD and in 58% of participants with moderate dementia. Participants with paratonia had lower Purdue Pegboard scores (P<0.001), lower balance coordination in semitandem stance (P<0.001), lower walking speed at a fast pace (P=0.001), and lower step regularity at normal (P=0.025) and fast (P<0.001) pace. Paratonia is already present in participants with MiD and is associated with a decline in both fine and gross motor performance. Early detection of paratonia might be helpful to detect persons at higher risk of motor deterioration and falls.

Initial and Long-term Retention of Robotic Technical Skills in an Otolaryngology Residency Program.

To objectively assess the initial and long-term retention of robotic surgical skills of otolaryngology residents. This study was performed in an academic otolaryngology residency training program. Between October 2015 and November 2016, residents were invited to complete a prospective, multiphase robotic surgical skills training course: 1) online da Vinci Surgical System Assessment and didactic, 2) faculty-supervised robotic simulator training, 3) robotic docking and draping training, 4) robotic dry-lab exercises. To optimize surgical skill retention, the training laboratory was repeated 2 weeks after the initial training session. Twenty otolaryngology residents were included. Primary outcome was measured as robotic skill assessment scores on three tasks: camera targeting, peg board, and needle targeting. Skill assessments were completed prior to training, between the two training sessions, and at 1 month and 6 months after training. Residents were also asked to complete a self-assessment questionnaire. Camera targeting scores were improved at midtraining (P < .001) and 1-month posttraining (P = .010). Peg board scores were improved at 1 month training (P = .043). Needle targeting scores were improved at midtraining (P = .002), 1 month (P = .002), and 6 months posttraining (P < .001). Resident self-assessment scores demonstrating comfort with using the robotic console (P < .01) and docking/draping (P < .01) improved significantly following the training. Following a multiphase robotic training program, otolaryngology residents demonstrated significant, objective skill acquisition and retention at 1 month and 6 months follow-up. Although the proposed training strategy may be considered an important step in otolaryngology residency training, additional innovations are being designed toward a formal robotic training curriculum. NA Laryngoscope, 129:1380-1385, 2019.

Higher fasting plasma glucose is associated with smaller striatal volume and poorer fine motor skills in a longitudinal cohort

Previous studies have demonstrated associations between higher blood glucose and brain atrophy and functional deficits, however, little is known about the association between blood glucose, striatal volume and striatal function despite sensori-motor deficits being reported in diabetes. This study investigated the relationship between blood glucose levels, striatal volume and fine motor skills in a longitudinal cohort of cognitively healthy individuals living in the community with normal or impaired fasting glucose or type 2 diabetes. Participants were 271 cognitively healthy individuals (mean age 63 years at inclusion) with normal fasting glucose levels (<5.6 mmol/L) (n=173), impaired fasting glucose (5.6–6.9 mmol/L) (n=57), or with type 2 diabetes (≥7.0 mmol/L) (n=41). Fasting glucose, Purdue Pegboard scores as measurement of fine motor skills, and brain scans were collected at wave 1, 2 and 4, over a total follow-up of twelve years. Striatal volumes were measured using FreeSurfer after controlling for age, sex and intracranial volume. Results showed that type 2 diabetes was associated with smaller right putamen volume and lower Purdue Pegboard scores after controlling for age, sex and intracranial volume. These findings add to the evidence suggesting that higher blood glucose levels, especially type 2 diabetes, may impair brain structure and function.

Investigating the impact of innate dexterity skills and visuospatial aptitude on the performance of baseline laparoscopic skills in veterinary students.

To determine if manual dexterity and visuospatial skills can be used to predict baseline laparoscopic surgery skills in veterinary students. Pilot study. Veterinary students (n = 45) from years 1-4 volunteered for this study. An hour-long electronic questionnaire was completed by participants. The first section was used to collect demographics and information about prior nonsurgical experiences. The second section included 3 tests of visuospatial skills, including the Purdue Visualization of Rotations Test, Mental Rotations Test, and Raven's Advanced Progressive Matrices Test. Multiple tests were administered to assess innate dexterity, including the grooved pegboard test, indirect and direct zigzag tracking tests, and the 3Dconnexion proficiency test. Each dexterity test was performed once with the left hand and once with the right hand. The order of task performance was randomized. Basic laparoscopic skills were assessed using the validated fundamentals of laparoscopic surgery (FLS) peg transfer task. There was an association between left-handed grooved pegboard scores (95% CI -10046.36 to -1636.53, P-value = .008) and left-handed indirect zigzag tracking task (95% CI -35.78 to -8.20, P-value = .003) with FLS peg transfer scores. Individuals who reported playing videogames achieved higher scores on the FLS peg transfer task than those without videogame experience (95% CI 583.59 to 3509.97, P-value = .007). The results of this study suggest that dexterity was a better predictor of baseline laparoscopic skills than visuospatial skills in veterinary students.

The Influence of Hand Immersion Duration on Manual Performance.

To investigate the effect of hand immersion duration on manipulative ability and tactile sensitivity. Individuals in maritime settings often work with hands that have been immersed in water. Although research has shown that hand immersion duration differentially impacts skin adhesion and tactile sensitivity, the effect of hand immersion on manipulative ability has not been directly tested. Given how critical manipulative ability is for the safety and performance of those working at sea, the effect of hand immersion duration on manual performance was investigated. Tests of manipulative ability (Purdue Pegboard, Grooved Pegboard, reef knot untying) and tactile sensitivity (Touch-Test) were completed following no-exposure, short-exposure, and long-exposure hand immersions in thermoneutral water. Compared to the no immersion condition, the Purdue Pegboard performance was reduced in both immersion conditions (short exposure, -11%; long exposure, -8%). A performance decrement was only observed in the short exposure condition (+15% in time to complete task) for the reef knot untying task. There were no statistical differences in the Grooved Pegboard or Touch-Test scores between exposure conditions. Immersing the hands in water decreases manipulative ability except for when object properties reduce the slipperiness between the hand and object. Manual performance in a wet environment may be conserved by designing tools and objects with edges and textures that can offset the slipperiness of wet hands. To maintain safety, the time requirements for working with wet hands needs to be considered.

Is mercury in Tibetan Medicine toxic? Clinical, neurocognitive and biochemical results of an initial cross-sectional study.

Mercury an important therapeutic substance in Tibetan Medicine undergoes complex "detoxification" prior to inclusion in multi-ingredient formulas. In an initial cross-sectional study, patients taking Tibetan Medicine for various conditions were evaluated for mercury toxicity. Two groups were identified: Group 1, patients taking " Tsothel" the most important detoxified mercury preparation and Group 2, patients taking other mercury preparations or mercury free Tibetan Medicine. Atomic fluorescence spectrometry of Tibetan Medicine showed mercury consumption 130 µg/kg/day (Group 1) and 30 µg/kg/day (Group 2) ( P ≤ 0.001), levels above EPA (RfDs) suggested threshold (0.3 µg/kg /day) for oral chronic exposure. Mean duration of Tibetan Medicine treatment was 9 ± 17 months (range 3-116) (Group 1) and 5 ± 1.96 months (range 1-114) (Group 2) (NS) with cumulative days of mercury containing Tibetan Medicine, 764 days ± 1214 (range 135-7330) vs. 103 days ± 111 (range 0-426), respectively ( P ≤ 0.001). Comparison of treatment groups with healthy referents (Group 3) not taking Tibetan Medicine showed no significant differences in prevalence of 23 non-specific symptoms of mercury toxicity, abnormal neurological, cardiovascular and dental findings and no correlation with mercury exposure variables; consumption, cumulative treatment days, blood/ urine Hg. Liver and renal function tests in treatment groups were not significantly increased compared to referents, with mean urine Beta2 Microglobulin within the normal range and not significantly associated with Hg exposure variables after correcting for confounding variables. Neurocognitive testing showed no significant intergroup differences for Wechsler Memory Scale, Grooved Pegboard, Visual Retention, but Group1 scores were better for Mini-Mental, Brief Word Learning, Verbal Fluency after correcting for confounding variables. These results suggest mercury containing Tibetan Medicine does not have appreciable adverse effects and may exert a possible beneficial effect on neurocognitive function. Since evidence of mercury as a toxic heavy metal, however, is well known, further analysis of literature on mercury use in other Asian traditional systems is highly suggested prior to further studies.

Synergy as a new and sensitive marker of basal ganglia dysfunction: A study of asymptomatic welders

BackgroundMulti-digit synergies, a recently developed, theory-based method to quantify stability of motor action, are shown to reflect basal ganglia dysfunction associated with parkinsonian syndromes. In this study, we tested the hypothesis that multi-digit synergies may capture early and subclinical basal ganglia dysfunction. We chose asymptomatic welders to test the hypothesis because the basal ganglia are known to be most susceptible to neurotoxicity caused by welding-related metal accumulation (such as manganese and iron). MethodsTwenty right-handed welders and 13 matched controls were invited to perform single- and multi-finger pressing tasks using the fingers of the right or left hand. Unified Parkinson⿿s Disease Rating Scale and Grooved Pegboard scores were used to gauge gross and fine motor dysfunction, respectively. High-resolution (3T) T1-weighted, T2-weighted, T1 mapping, susceptibility, and diffusion tensor MRIs were obtained to reflect manganese, iron accumulation, and microstructural changes in basal ganglia. The synergy index stabilizing total force and anticipatory synergy adjustments were computed, compared between groups, and correlated with estimates of basal ganglia manganese [the pallidal index, R1 (1/T1)], iron [R2* (1/T2*)], and microstructural changes [fractional anisotropy and mean diffusivity]. ResultsThere were no significant differences in Unified Parkinson⿿s Disease Rating Scale (total or motor subscale) or Grooved Pegboard test scores between welders and controls. The synergy index during steady-state accurate force production was decreased significantly in the left hand of welders compared to controls (p=0.004) but did not reach statistical significance in the right hand (p=0.16). Anticipatory synergy adjustments, however, were not significantly different between groups. Among welders, higher synergy indices in the left hand were associated significantly with higher fractional anisotropy values in the left globus pallidus (R=0.731, p<0.001) but not with the pallidal index, R1, or R2* values in the basal ganglia. ConclusionsThese data suggest that multi-digit synergy metrics may serve as preclinical markers for basal ganglia dysfunction in welders and other populations at risk for neurodegenerative diseases involving parkinsonian symptoms. This finding may have important clinical, scientific, and public/occupational health implications.

Effect of white matter lesions on manual dexterity in healthy middle-aged persons.

We hypothesized that integrated motor-visual functions measured by manipulative manual dexterity are affected by white matter lesion (WML) burden as measured on cranial MRI across relevant brain regions in subjects at risk of preclinical occult vascular disease. A real-time cross-sectional study of healthy subjects aged 29 to 74 years with a family history of early-onset coronary artery disease (n = 714; mean age, 51 ± 11 years; mean education, 14 ± 3 years; 42% male; 38% black) were identified from probands with coronary artery disease diagnosed before age 60 years. WMLs on 3-tesla brain MRI and Grooved Pegboard scores were measured. WMLs were observed at all ages. Mean pegboard scores were 108 ± 18, similar to normal populations. In unadjusted analysis, WMLs and pegboard scores were significantly correlated by region (total WMLs, r = 0.34, p = 0.0001; frontal [r = 0.34, p < 0.0001], insula [r = 0.31, p < 0.0001], parietal [r = 0.31, p < 0.0001], and temporal [r = 0.17, p < 0.0001]). In multivariate analysis predicting (log) pegboard score adjusted for age, sex, race, education, regional or total volumes, and familial non-independence, total WML volume (p = 5.79E - 05) and regional WML volumes (p < 0.01) retained statistical significance in all but the youngest age quartile (29-43 years). Greater WML volumes in different brain regions are associated with higher pegboard scores (worse performance) independent of age, sex, race, education, and total or regional volumes. This suggests that small vessel cerebrovascular disease may be present in healthy individuals in a preclinical state with measurable impact on complex integrative functions in individuals with excess risk of clinical vascular disease.

A follow-up study of neurobehavioral functions in welders exposed to manganese

Welders may be exposed to high amounts of manganese (Mn). In this study 63 welders and 65 referents were followed up with neurobehavioral tests approximately 6 years after the initial examination at baseline. The welders were exposed to the geometric mean (GM) Mn concentration of 116μg/m3 at baseline and 148μg/m3 at follow-up. Their mean duration of employments as welders was 19.5 years at follow-up. Being exposed as a welder was associated with a decline between baseline and follow-up in the performance on the Static Steadiness Test, Finger Tapping Test and Grooved Pegboard Test. However, the decline was also associated with having high concentrations of carbohydrate deficient transferrin in serum (sCDT), indicating high alcohol consumption. When subjects with sCDT above the upper reference limit of the laboratory (≥1.7%) were excluded from the analyses, no difference in the decline in performance was observed between welders and referents for any of the applied neurobehavioral tests. Three welders had developed bradykinesia at follow-up, as assessed by a substantial decline in their Finger Tapping Test performance. They had also experienced a severe decline in Foot Tapping, Grooved Pegboard and Postural Sway Test scores (while blindfolded), while postural tremor as assessed with the CATSYS Tremor 7.0 was normal. Their neurobehavioral test performance at baseline 6 years previously had been normal.

Neurodevelopmental outcomes in HIV-exposed-uninfected children versus those not exposed to HIV

Human immunodeficiency virus (HIV)-negative children born to HIV-infected mothers may exhibit differences in neurodevelopment (ND) compared to age- and gender-matched controls whose lives have not been affected by HIV. This could occur due to exposure to HIV and antiretroviral agents in utero and perinatally, or differences in the environment in which they grow up. This study assessed neurodevelopmental outcomes in HIV-exposed uninfected (HEU) and HIV-unexposed uninfected (HUU) children enrolled as controls in a multicenter ND study from Thailand and Cambodia. One hundred sixty HEU and 167 HUU children completed a neurodevelopmental assessment using the Beery Visual Motor Integration (VMI) test, Color Trails, Perdue Pegboard, and Child Behavior Checklist (CBCL). Thai children (n = 202) also completed the Wechsler Intelligence Scale (IQ) and Stanford-Binet II memory tests. In analyses adjusted for caregiver education, parent as caregiver, household income, age, and ethnicity, statistically significant lower scores were seen on verbal IQ (VIQ), full-scale IQ (FSIQ), and Binet Bead Memory among HEU compared to HUU. The mean (95% CI) differences were −6.13 (−10.3 to −1.96), p = 0.004; −4.57 (−8.80 to −0.35), p = 0.03; and −3.72 (−6.57 to −0.88), p = 0.01 for VIQ, FSIQ, and Binet Bead Memory, respectively. We observed no significant differences in performance IQ, other Binet memory domains, Color Trail, Perdue Pegboard, Beery VMI, or CBCL test scores. We conclude that HEU children evidence reductions in some neurodevelopmental outcomes compared to HUU; however, these differences are small and it remains unclear to what extent they have immediate and long-term clinical significance.