It is currently unknown whether speech and limb motor effectors in Parkinson's disease (PD) are controlled by similar underlying brain processes. Based on computerized objective analysis, the aim of this study was to evaluate potential correlation between speech and mechanical tests of upper limb motor function. Speech and upper limb motor tests were performed in 22 PD patients and 22 healthy controls. Quantitative acoustic analyses of eight key speech dimensions of hypokinetic dysarthria, including quality of voice, sequential motion rates, consonant articulation, vowel articulation, average loudness, loudness variability, pitch variability, and number of pauses, were performed. Upper limb movements were assessed using the motor part of the Unified Parkinson's Disease Rating Scale, contactless three-dimensional motion capture system, blinded expert evaluation, and the Purdue Pegboard Test. Significant relationships were observed between the quality of voice assessed by jitter and amplitude decrement of finger tapping (r = 0.61, p = 0.003), consonant articulation evaluated using voice onset time and expert rating of finger tapping (r = 0.60, p = 0.003), and number of pauses and Purdue Pegboard Test score (r = 0.60, p = 0.004). The current study supports the hypothesis that speech impairment in PD shares, at least partially, similar pathophysiological processes with limb motor dysfunction. Vocal fold vibration irregularities appeared to be influenced by mechanisms similar to amplitude decrement during repetitive limb movements. Consonant articulation deficits were associated with decreased manual dexterity and movement speed, likely reflecting fine motor control involvement in PD.
- MeSH
- antiparkinsonika terapeutické užití MeSH
- horní končetina patofyziologie MeSH
- lidé středního věku MeSH
- lidé MeSH
- měření tvorby řeči MeSH
- Parkinsonova nemoc komplikace farmakoterapie patofyziologie MeSH
- pohybová aktivita * fyziologie MeSH
- poruchy řeči etiologie patofyziologie MeSH
- senioři nad 80 let MeSH
- senioři MeSH
- stupeň závažnosti nemoci MeSH
- Check Tag
- lidé středního věku MeSH
- lidé MeSH
- mužské pohlaví MeSH
- senioři nad 80 let MeSH
- senioři MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- srovnávací studie MeSH
PURPOSE: Multiple system atrophy (MSA) is a rare neurodegenerative disease that remains poorly understood, and the diagnosis of MSA continues to be challenging. We endeavored to improve the diagnostic process and understanding of in vivo characteristics of MSA by diffusion tensor imaging (DTI). MATERIALS AND METHODS: Twenty MSA subjects, ten parkinsonian dominant (MSA-P), ten cerebellar dominant (MSA-C), and 20 healthy volunteer subjects were recruited. Fractional anisotropy, mean diffusivity, radial diffusivity, and axial diffusivity maps were processed using tract-based spatial statistics. Diffusion data were additionally evaluated in the basal ganglia. A support vector machine was used to assess diagnostic utility, leave-one-out cross-validation in the evaluation of classification schemes, and receiver operating characteristic analyses to determine cutoff values. RESULTS: We detected widespread changes in the brain white matter of MSA subjects; however, no group-wise differences were found between MSA-C and MSA-P subgroups. Altered DTI metrics in the putamen and middle cerebellar peduncles were associated with a positive parkinsonian and cerebellar phenotype, respectively. Concerning clinical applicability, we achieved high classification performance on mean diffusivity data in the combined bilateral putamen and middle cerebellar peduncle (accuracy 90.3%±9%, sensitivity 86.5%±11%, and specificity 99.3%±4%). CONCLUSION: DTI in the middle cerebellar peduncle and putamen may be used in the diagnosis of MSA with a high degree of accuracy.
- Publikační typ
- časopisecké články MeSH
INTRODUCTION: Timed performance tests were introduced to overcome the disadvantages of subjective evaluation of bradykinesia in Parkinson's disease (PD). We aimed to verify their discriminative properties and compare them with the motion capture analysis of finger tapping. METHODS: We included 22 PD patients (10 M, 12 F), mean age 64 (range 48-82) yrs, Hoehn & Yahr stage 2 (1-2.5) and 22 (10 M, 12 F) normal controls, mean age 66 (41-82) yrs. The key tapping subtest of the Halstead-Reitan battery, the Purdue Pegboard test, and the Bradykinesia-Akinesia Incoordination (BRAIN) test were performed according to the test manuals. The finger tapping subtest of the UPDRS-III, item 23 was recorded using a contactless 3D motion capture system Optitrack-V120. Average frequency (AvgFrq), maximum opening velocity (MaxOpV) and amplitude decrement (AmpDec) were computed and simultaneous video recordings of finger tapping were rated by two experts. RESULTS: The AmpDec and MaxOpV motion capture measures best differentiated between PD patients and controls (AUC = 0.87 and 0.81). Of the instrumental tests, only the Purdue Pegboard attained significance in differentiating PD patients from controls (AUC = 0.80). In PD patients, MaxOpV correlated with the finger tapping ratings and BRAIN test, and AvgFrq correlated with the BRAIN and Halstead-Reitan test scores. Moreover, correlations were found between the Purdue Pegboard and finger tapping ratings. CONCLUSIONS: Contactless 3D motion capture of finger tapping allowed an independent analysis of individual components of bradykinesia, demonstrating the amplitude decrement and maximum opening velocity as the most powerful discriminators between PD patients and controls.
- MeSH
- dospělí MeSH
- hypokineze etiologie patofyziologie MeSH
- lidé středního věku MeSH
- lidé MeSH
- Parkinsonova nemoc komplikace patofyziologie MeSH
- prsty ruky MeSH
- psychomotorický výkon fyziologie MeSH
- senioři nad 80 let MeSH
- senioři MeSH
- Check Tag
- dospělí MeSH
- lidé středního věku MeSH
- lidé MeSH
- mužské pohlaví MeSH
- senioři nad 80 let MeSH
- senioři MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- práce podpořená grantem MeSH
- Publikační typ
- abstrakt z konference MeSH
BACKGROUND: Falls are a common complication of advancing Parkinson's disease (PD). Although numerous risk factors are known, reliable predictors of future falls are still lacking. The objective of this prospective study was to investigate clinical and instrumented tests of balance and gait in both OFF and ON medication states and to verify their utility in the prediction of future falls in PD patients. METHODS: Forty-five patients with idiopathic PD were examined in defined OFF and ON medication states within one examination day including PD-specific clinical tests, instrumented Timed Up and Go test (iTUG) and computerized dynamic posturography. The same gait and balance tests were performed in 22 control subjects of comparable age and sex. Participants were then followed-up for 6 months using monthly fall diaries and phone calls. RESULTS: During the follow-up period, 27/45 PD patients and 4/22 control subjects fell one or more times. Previous falls, fear of falling, more severe motor impairment in the OFF state, higher PD stage, more pronounced depressive symptoms, higher daily levodopa dose and stride time variability in the OFF state were significant risk factors for future falls in PD patients. Increased stride time variability in the OFF state in combination with faster walking cadence appears to be the most significant predictor of future falls, superior to clinical predictors. CONCLUSION: Incorporating instrumented gait measures into the baseline assessment battery as well as accounting for both OFF and ON medication states might improve future fall prediction in PD patients. However, instrumented testing in the OFF state is not routinely performed in clinical practice and has not been used in the development of fall prevention programs in PD. New assessment methods for daylong monitoring of gait, balance and falls are thus required to more effectively address the risk of falling in PD patients.
- MeSH
- chůze (způsob) účinky léků fyziologie MeSH
- chůze fyziologie MeSH
- levodopa terapeutické užití MeSH
- lidé středního věku MeSH
- lidé MeSH
- Parkinsonova nemoc farmakoterapie patofyziologie MeSH
- posturální rovnováha účinky léků fyziologie MeSH
- prospektivní studie MeSH
- rizikové faktory MeSH
- senioři nad 80 let MeSH
- senioři MeSH
- strach fyziologie MeSH
- stupeň závažnosti nemoci MeSH
- úrazy pádem prevence a kontrola MeSH
- Check Tag
- lidé středního věku MeSH
- lidé MeSH
- mužské pohlaví MeSH
- senioři nad 80 let MeSH
- senioři MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- práce podpořená grantem MeSH
- Publikační typ
- abstrakt z konference MeSH
V neurologické diagnostice se SPECT využívá pouze na specializovaných pracovištích v relativně omezeném počtu indikací, a to zejména: 1) u pacientů s farmakorezistentní epilepsií v rámci vyšetřovacího programu před epileptochirurgickým zákrokem, 2) v diferenciální diagnostice parkinsonského syndromu, 3) k posouzení funkčního stavu cévního řečiště u pacientů s uzávěrem vnitřní karotidy nebo stenózou intrakraniálních tepen.
In neurological diagnostics, Single Photon Emission Computed Tomography (SPECT) is used only in a limited number of indications, mainly: 1) in presurgical assessment of refractory epilepsy patients, 2) in differential diagnostics of parkinsonian syndrome, 3) to assess functional cerebrovascular reserve in patients with internal carotic or intracerebral artery stenosis.
- MeSH
- čas MeSH
- cerebrovaskulární poruchy diagnóza MeSH
- diferenciální diagnóza MeSH
- epilepsie MeSH
- intrakraniální arteriální nemoci diagnóza MeSH
- ischemie mozku diagnóza patofyziologie MeSH
- jednofotonová emisní výpočetní tomografie * klasifikace využití MeSH
- klinické zkoušky jako téma MeSH
- lidé MeSH
- mozek patofyziologie MeSH
- nemoci arterie carotis diagnóza MeSH
- nemoci bazálních ganglií diagnóza MeSH
- neurologie MeSH
- perfuze MeSH
- předoperační péče MeSH
- radiofarmaka MeSH
- senzitivita a specificita MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- práce podpořená grantem MeSH
The Grooved Pegboard Test (GPT) was conceived as a test of manual dexterity, upper-limb motor speed, and hand-eye coordination. The aim of our study was to test the componential structure of the GPT on an archetypal model of motor impairment, Parkinson's disease (PD). A total of 45 PD patients (33 males, 12 females; age M = 67, range = 49-81; PD duration M = 10, range = 6-20 years; H/Y stage 2, range = 2-3) and 20 age- and education-matched controls (14 males, 6 females; age M = 66, range = 48-80) were included. All participants were investigated using the GPT, Short Falls Efficacy Scale-International, Frontal Assessment Battery (FAB), Montreal Cognitive Assessment (MoCA), and Non-Motor Symptom Scale. Patients were followed for 6 months, using fall diaries and monthly phone calls to define PD fallers (falls ≥ 1; n = 27) and PD nonfallers (falls = 0; n = 18). Using structural equation modeling, the GPT predicted performance on the MoCA (p < .001), but not on the FAB (p = .29). In conclusion, analysis of the structure of the GPT provided evidence about important cognitive features, in addition to the motor component of this test in PD.
- MeSH
- kognice fyziologie MeSH
- lidé středního věku MeSH
- lidé MeSH
- neuropsychologické testy * MeSH
- Parkinsonova nemoc patofyziologie psychologie MeSH
- pohybová aktivita fyziologie MeSH
- senioři nad 80 let MeSH
- senioři MeSH
- Check Tag
- lidé středního věku MeSH
- lidé MeSH
- mužské pohlaví MeSH
- senioři nad 80 let MeSH
- senioři MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- práce podpořená grantem MeSH
- Publikační typ
- abstrakt z konference MeSH
