Anxiety has been implicated as one of the greatest influences on quality of life in Parkinson's disease (PD). The etiology of anxiety is unclear, although previous work suggests that anxiety may be ...linked to sensory deficits that cause uncertainty in movement. Thus, the current study examined whether focusing attention on sensory feedback during goal-based exercise has the potential to provide benefits to anxiety in PD. Thirty-five participants with PD were randomized to either a Sensory Attention Focused Exercise (SAFEx) (i.e. internal focus of attention, n = 18) or Sham Exercise control (i.e. external focus of attention, n = 17) and completed 33 one-hour attention-based exercise sessions over 11-weeks. Before and after the program (pre and post), participants completed the Parkinson Anxiety Scale (PAS) questionnaire. The PAS includes three anxiety sections: persistent, episodic, and avoidance. Changes in the total PAS score and within each section of the PAS were subjected to two-factor mixed repeated measures ANCOVA. Significant group by time interactions demonstrated that from pre to post, total PAS scores (p = 0.007) and episodic anxiety scores (p = 0.010) significantly decreased in the SAFEx group only (ΔTotal PAS = -5.2, F(1,27) = 5.41, p = 0.028, ηp2 = 0.17; ΔEpisodic Score = -1.8, F(1,27) = 6.89, p = 0.014, ηp2 = 0.20). In conclusion, focusing attention on sensory feedback while completing goal-based exercises may provide significant benefits to improving anxiety in PD. As such, sensory attention focused exercise may be a critical adjunct therapy for improving anxiety, and ultimately quality of life in people with PD.
Management of PD has largely been affected by COVID-19. Due to the restrictions posed by COVID-19, there has been a shift from in-person to online forms of assessment. This presents a challenge as ...not all motor symptoms can be assessed virtually. Two of the four cardinal symptoms of PD (rigidity and postural instability) cannot be assessed virtually using the gold-standard Unified Parkinson's Disease Rating Scale (UPDRS-III). As a result, an accurate total motor severity score can not be computed from the remaining subsections. Recently, one study stated that in order for accurate scores to be calculated, only three sections could be absent. Virtually, six sections are unable to be evaluated with online assessments. This inability to compute a total motor severity score may result in poor disease management. Thus, in this study a regression equation was developed to predict total motor severity scores from partial scores.
Total motor severity scores (UPDRS-III) from N = 234 individuals with idiopathic Parkinson's were retrospectively analyzed. In order to conduct a linear regression analysis predictor and outcome variables were created. The variables were then used for the linear regression. The equation was then tested on an independent data set N = 1168.
The regression analysis resulted in the equation to predict total motor symptom severity of PD.
In conclusion, the developed equation will be very useful for outreach in rural communities, as well as the continued remote management of PD during COVID-19 and beyond.
•We have developed a regression equation that can accurately predict full UPDRS-III scores.•This equation can be utilized during the COVID-19 era and beyond in rural communities where specialists may not be readily available.
Background
Freezing of gait (FOG) is arguably the most disabling motor symptom experienced with Parkinson’s disease (PD), but treatments are extremely limited due to our poor understanding of the ...underlying mechanisms. Three cortical domains are postulated in recent research (ie, the cognitive, limbic, and sensorimotor domains), thus, treatments targeting these mechanisms of FOG may potentially be effective. Cognitive training, cognitive behavioral therapy (CBT, a well-known anxiety intervention), and proprioceptive training may address the cognitive, limbic, and sensorimotor domains, respectively.
Objective
To investigate whether these 3 treatments could improve functional outcomes of FOG.
Methods
In a single-blind, randomized crossover design, 15 individuals with PD and FOG were randomized into different, counterbalanced orders of receiving the interventions. Each consisted of eight 1-hour sessions, twice weekly for 4 weeks. FOG severity was assessed as the primary outcome using a novel gait paradigm that was aimed at evoking FOG when the cognitive, limbic, or sensorimotor domains were independently challenged.
Results
FOG severity significantly improved after the cognitive intervention, with strong trends toward improvement specifically in the baseline and cognitive-challenge assessment conditions. CBT, as the anxiety intervention, resulted in significantly worse FOG severity. In contrast, proprioceptive training significantly improved FOG severity, with consistent trends across all conditions.
Conclusions
The cognitive and proprioceptive treatments appeared to improve different aspects of FOG. Thus, either of these interventions could potentially be a viable treatment for FOG. However, although the results were statistically significant, they could be sensitive to the relatively small number of participants in the study. Considering the significant results together with nonsignificant trends in both FOG and gait measures, and given equal time for each intervention, proprioceptive training produced the most consistent indications of benefits in this study. (clinicaltrials.gov NCT03065127).
Abstract
Background
Parkinson disease (PD) impairs control of well-learned movements. Movement control improvements are found when individuals complete tasks while focusing attention externally on ...manipulating an object, which is argued to occur due to automatic processing associated with well-learned movements. Focusing attention internally (on movements of one's limbs) is believed to involve conscious control networks and hinders movement performance. Previous work has shown that an external focus of attention (EFA) improved postural stability in individuals with PD (compared with an internal focus of attention IFA), but this improvement occurred when patients were taking dopamine medication, which modulates basal ganglia functioning responsible for well-learned movements.
Objective
The purpose of this study was to determine whether an EFA or IFA is beneficial for postural stability in individuals with PD in the absence of dopamine replacement.
Design
A within-participant design was utilized.
Methods
Nineteen individuals with PD stood on a firm, unstable platform in 3 attentional conditions: (1) EFA, (2) IFA, and (3) control (participant asked to stand still). Displacement and variability of anterior-posterior and medial-lateral postural sway were measured with a balance system for fall risk assessment. The protocol was completed both “on” and “off” (mininum 12-hour withdrawal of) dopaminergic medications.
Results
While off medications, anterior-posterior sway variability was significantly lower during an IFA compared with the EFA and control. Anterior-posterior sway displacement and variability were significantly lower during the IFA, when off medications were compared with IFA and EFA while on medications.
Limitations
There was no comparison with a healthy age-matched control group, and a safety harness was used due to task difficulty.
Conclusions
An EFA may recruit automatic processes that involve degenerated basal ganglia in PD, and absence of dopamine exacerbates dysfunction. Training with an EFA may improve upon these automatic processes in individuals with PD.
Abstract Background Despite the strong association between turning and Freezing of gait (FOG) in Parkinson's disease (PD), there has been little research to evaluate the specific turn characteristics ...(i.e. turn angles) that might contribute to freezing. Therefore, the purpose of the present study has three aims: examine the turning gait kinematics in freezers, evaluate the prevalence of FOG at different turn angles, and characterize whether the specific turning strategies employed by PD patients might be associated with turning deficits. Methods 20 PD participants (10 freezers, 10 non-freezers) and 10 healthy controls walked down a 6-m pathway and completed randomized trials of 0°, 90°, 120°, and 180° turns. Spatiotemporal gait kinematics were analysed using motion capture, while presence of FOG and classification of turn types (step out, crossover, or mixed strategy) were identified by two independent raters using video analysis. Results Freezers significantly increased step time variability and elicited more freezing episodes at sharper turns. Healthy controls consistently implemented a crossover turning strategy for all turning angles, while freezers tended to use a step out and mixed strategy especially during 180° turns. This strategy in freezers was associated with a failure to increase step width (as healthy controls do). Additionally, in contrast to healthy controls and non-freezers, a dramatic decrease in velocity was identified in freezers for all turning angles. Conclusions Freezing episodes are associated with a deficit in controlling gait timing. Additionally, freezers fail to increase step width despite employing a safer turn strategy.
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.
Recent studies have suggested that vibration therapy may have a positive influence in treating motor symptoms of Parkinson's disease (PD). However, quantitative evidence of the benefits of vibration ...utilized inconsistent methods of vibration delivery, and to date there have been no studies showing a long-term benefit of 40 Hz vibration in the PD population. The objective of this study was to demonstrate the efficacy of vibration administered via a physioacoustic therapy method (PAT) on motor symptoms of PD over a longer term, completed as a randomized placebo-controlled trial. Overall motor symptom severity measured by the Unified Parkinson's Disease Rating Scale III showed significant improvements in the treatment group over 12 weeks. Specifically, all aspects of PD, including tremor, rigidity, bradykinesia, and posture and gait measures improved. To our knowledge, this is the first study to quantitatively assess 40-Hz vibration applied using the PAT method for potential long-term therapeutic effects on motor symptoms of PD.
In order to understand how dopamine modulates the effect of anxiety on gait, the goal of this study was to use virtual reality to provoke anxiety in Parkinson's disease (PD) (in both ON and OFF ...states) and quantify its effect on gait. Seventeen participants with PD and 20 healthy age‐matched controls were instructed to walk in a virtual environment in two anxiety‐provoking conditions: (i) across a plank that was located on the GROUND and (ii) across an ELEVATED plank. All participants with PD completed this experiment in both the ON and OFF states, and were then striated into groups based on baseline trait anxiety scores for further analyses. Anxiety (skin conductance and self‐report) and spatiotemporal aspects of gait were measured. Overall, the ELEVATED condition resulted in greater skin conductance levels and self‐reported anxiety levels. Additionally, all participants demonstrated slower gait with increased step‐to‐step variability when crossing the ELEVATED plank compared with the plank on the GROUND. The results showed that dopaminergic treatment selectively improved gait in only the highly anxious PD group, by significantly improving velocity, step length, step time and step‐to‐step variability specifically when walking across the ELEVATED plank (ON vs. OFF comparison). In conclusion, only highly trait anxious participants with PD benefitted from dopaminergic treatment, specifically when walking in the anxiety‐provoking environment. Improvements to gait during anxious walking might be a result of dopaminergic medication acting in two ways: (i) improving the basal ganglia's capacity to process information and (ii) reducing the load from anxiety and subsequently making more resources available to effectively process other competing inputs.
Dopaminergic treatment reduces self‐reported anxiety levels in PD when walking in threatening and non‐threatening environments. Dopaminergic treatment can also improve gait in threatening environments but only in PD patients with high trait levels of anxiety. Notably, those with PD who are highly anxious demonstrate similar gait characteristics to those who have severe gait impairments such as freezing of gait.
•Only aerobic exercise improved executive functions in individuals with PD.•Cognitive domains linked to risk of dementia in PD did not change after exercise.•Patients with cognitive impairment in the ...Control group were worse at post-test.
Little is known about how different exercise modalities influence cognition in Parkinson’s disease (PD). Moreover, the focus of previous investigations on examining the effects of exercise mainly on executive functions and the exclusion of individuals with cognitive impairment may limit the potential to define exercise as a treatment for cognitive decline in PD.
The aim of this study was to compare the effects of aerobic and goal-based exercise on five cognitive domains in cognitively normal and impaired individuals with PD.
Seventy-six individuals with PD were randomly allocated into three groups: Aerobic, Goal-based, and Control. Participants in the exercise groups attended 1-h sessions 3x/week for 12 weeks, while those in the Control group carried on with their regular activities. Changes in cognitive domains were assessed using paper-based neuropsychological tests.
Inhibitory control improved only in the Aerobic group (p = .04), irrespective of participants cognitive status at baseline. Moreover, participants with cognitive impairment in Aerobic group maintained their set-shifting ability, whereas those in the Control group were worse at post-test (p = .014).
This is the first study to show that aerobic exercise is more effective than goal-based exercise for the treatment of cognition in PD with and without cognitive impairment.
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