INTRODUCTION: Bradykinesia is an essential diagnostic criterion for Parkinson's disease (PD) but is frequently observed in many non-parkinsonian movement disorders, complicating differential diagnosis, particularly in disorders featuring tremors. The presence of bradykinetic features in the subset of dystonic tremors (DT), either "pure" dystonic tremors or tremors associated with dystonia, remains currently unexplored. The aim of the current study was to evaluate upper limb bradykinesia in DT patients, comparing them with healthy controls (HC) and patients with PD by observing repetitive finger tapping (FT). METHODS: The protocol consisted of two main parts. Initially, the kinematic recording of repetitive FT was performed using optical hand tracking system (Leap Motion Controller). The values of amplitude, amplitude decrement, frequency, frequency decrement, speed, acceleration and number of halts of FT were calculated. Subsequently, three independent movement disorder specialists from different movement disorders centres, blinded to the diagnosis, rated the presence of FT bradykinesia based on video recordings. RESULTS: Thirty-six subjects participated in the study (12 DT, 12 HC and 12 early-stage PD). Kinematic analysis revealed no significant difference in the selected parameters of FT bradykinesia between DT patients and HC. In comparisons between DT and PD patients, PD patients exhibited bigger amplitude decrement and slower FT performance. In the blinded clinical assessment, bradykinesia was rated, on average, as being present in 41.6% of DT patients, 27.7% of HC, and 91.7% of PD patients. While overall inter-rater agreement was moderate, weak agreement was noted within the DT group. DISCUSSION: Clinical ratings indicated signs of bradykinesia in almost half of DT patients. The objective kinematic analysis confirmed comparable parameters between DT and HC individuals, with more pronounced abnormalities in PD across various kinematic parameters. Interpretation of bradykinesia signs in tremor patients with DT should be approached cautiously and objective motion analysis might complement the diagnostic process and serve as a decision support system in the choice of clinical entities.
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- časopisecké články MeSH
Cieľ: Cieľom tejto práce bolo overenie psychometrických charakteristík slovenskej verzie Mattisovej škály demencie (Dementia Rating Scale-2; DRS-2), preskúmanie jej diagnostickej presnosti v populácii pacientov s Parkinsonovou chorobou (PCh) a stanovenie predbežného hraničného skóre pre diagnostiku miernej kognitívnej poruchy (mild cognitive impairment; MCI). Súbor a metodika: Klinická populácia bola zložená z 30 pacientov s PCh, s priemernou dĺžkou trvania ochorenia 5,53 ± 3,92 rokov. U 11 pacientov bola diagnostikovaná MCI. Kontrolnú skupinu zdravých ľudí bez neurologického ochorenia tvorilo 43 vekovo a vzdelanostne príbuzných participantov. Všetkým participantom bola administrovaná slovenská verzia DRS-2 merajúca pozornosť, pamäť, iniciáciu/perseveráciu, konštrukčné schopnosti a konceptualizáciu. Na posúdenie konvergentnej validity bola využitá komplexná neuropsychologická batéria. Výsledky: Korelácie skóre DRS-2 so skríningovými nástrojmi a analogickými testami neuropsychologickej batérie poukazujú na dobrú konvergentnú validitu nástroja (s výnimkou subtestu konštrukcia). Najsilnejšie vzťahy sme zistili pre subtesty iniciácia/perseverácia a pamäť. Objektivizovali sme dobrú diskriminačnú silu pri pacientoch s PCh bez kognitívneho deficitu a pacientoch s MCI so stanovením optimálneho cut-off skóre 134 bodov (senzitivita 81,80 % a špecificita 89,50 %). Záver: Slovenská verzia Mattisovej škály demencie je nástrojom s vyhovujúcimi psychometrickými vlastnosťami a možno ju potenciálne použiť na testovanie kognície u zdravej populácie a pacientov s Parkinsonovou chorobou.
Aim: Aims of this study were to verify the psychometric characteristics of the Slovak version of the Mattis Dementia Rating Scale-2 (DRS-2), examine its diagnostic accuracy in the population of patients with Parkinson‘s disease (PD), and establish a preliminary cut-off score for the diagnosis of mild cognitive impairment (MCI). Sample and methods: The clinical population consisted of 30 patients with PD with an average duration of the disease of 5.53 ± 3.92 years. Eleven patients were diagnosed with MCI. The control group of healthy people without neurological disease consisted of 43 participants who were age and education matched. All participants were administered the Slovak version of the DRS-2 measuring attention, memory, initiation/perseveration, construction skills and conceptualization. A comprehensive neuropsychological battery was used to assess convergent validity. Results: Correlations of DRS-2 scores with a screening tools and analogous tests of the neuropsychological battery indicate good convergent validity of the tool (with the exception of the construction subtest). We found the strongest relationships for the initiation/perseveration and memory subtests. Furthermore, we objectified a good discriminative power in patients with PD without cognitive deficits and patients with MCI with the determination of an optimal cut-off score of 134 points (sensitivity 81.80% and specificity 89.50%). Conclusion: The Slovak version of the DRS-2 is an instrument with satisfactory psychometric properties and can potentially be used to test cognition in the healthy population and patients with Parkinson‘s disease.
