Journal of Movement Disorders最新文献

Objective: Exercises have been proposed as adjuvants for the treatment of Parkinson's disease (PD); however, responses to exercise interventions have shown inconsistent results. We investigated the clinical factors associated with improvements in motor deficits after exercise.

Methods: A total of 85 patients with PD were enrolled from five tertiary hospitals and classified into four exercise groups: home exercise, strength training, Tai Chi, and yoga groups. Clinical measurements of the motor and nonmotor features of patients with PD were performed at baseline and 12 weeks after the exercise intervention. We employed principal component analysis (PCA) to reduce variables into ten factors and then examined associations of baseline characteristics with percentage improvement in the Movement Disorder Society sponsored Unified Parkinson's Disease Rating Scale Part III (MDS-UPDRS III) score via a Bayesian regression model.

Results: In the multivariate Bayesian regression model including ten PCA-derived factors, the percentage improvement in the MDS-UPDRS III score was associated with factors including prominent motor deficits (posterior interval [mean±standard deviation]: 2.5±1.5) and nonmotor symptoms such as depression, anxiety, and subjective memory impairment (3.3±1.7). Another factor related to functional impairments in gait and postural control was associated with less improvement after the exercise intervention (-3.9±1.7). According to the subgroup analyses, motor features were associated with improvements in the home exercise and strength training groups, whereas mood disturbance, fatigue, and subjective cognitive impairment were related to changes in the home exercise and Tai Chi groups.

Conclusion: Our results suggest that the individual phenotypes of patients with PD may be associated with clinical improvement following exercise.

Objective: Freezing of gait (FOG) significantly affects quality of life and increases the risk of falls in patients with Parkinson's disease (PD). Although deep brain stimulation (DBS) of the globus pallidus interna (GPi) is effective in managing motor complications, its efficacy in treating FOG remains inconsistent. This study aimed to determine whether preoperative structural brain connectivity can predict both the presence of FOG and its postoperative improvement following GPi DBS.

Methods: We retrospectively analyzed 58 patients with PD who underwent GPi DBS. Preoperative diffusion tensor imaging was used to assess structural connectivity between the volume of activated tissue (VAT) and 82 cortical regions. Machine learning models were developed to predict baseline FOG and postoperative FOG improvement (defined as a ≥1- or ≥2-point reduction) using demographic and connectivity features.

Results: Machine learning models incorporating structural connectivity features between the VAT and cortical regions-including the prefrontal, cingulate, and premotor cortices-outperformed models based solely on demographic variables in predicting both the presence of preoperative FOG and postoperative improvement. For example, the support vector machine model to predict FOG improvement (≥1-point improvement) achieved an accuracy of 0.65 with demographic data alone, which increased to 0.77 with the addition of structural connectivity features. Similar performance enhancements were observed in sensitivity analyses using stricter FOG thresholds (≥2-point improvement).

Conclusion: Preoperative structural connectivity between the GPi and key cortical regions involved in cognitive control and motor planning predicts FOG responsiveness to DBS. These.

Results: highlight the utility of connectomic biomarkers for personalizing DBS strategies and optimizing therapeutic outcomes in patients with advanced PD.

Objective: This pilot study aimed to evaluate the feasibility and potential effects of biofeedback therapy (BT) on anxiety and depression among patients with Parkinson's disease (PD).

Methods: A randomized waitlist-controlled trial was conducted involving 19 patients with PD and comorbid anxiety and/or depression. Anxiety and depression were assessed at baseline, posttreatment, and 1-month follow-up.

Results: All 19 patients completed the study. Compared with those of the control group, significant improvements in the Hamilton Depression Rating Scale and the anxiety subscale (but not the depression subscale) of the Hospital Anxiety and Depression Scale were observed immediately after BT. In the pooled analysis, the anxiolytic effect persisted at the 1-month follow-up, with greater improvements observed in those with more severe baseline anxiety.

Conclusion: These preliminary findings suggest that BT may help reduce anxiety symptoms among PD patients. Future studies with larger, more severely affected cohorts are needed to confirm these findings.

Objective: Clinical heterogeneity exists in the optimal timing and dosage of symptomatic treatments for Parkinson's disease (PD). This study aimed to cluster PD patients on the basis of longitudinal trajectories of levodopa equivalent daily dose (LEDD) and evaluate the clinical features and progression associated with these clusters.

Methods: From the Parkinson's Progression Markers Initiative database, we enrolled 301 PD patients who were followed up for at least 3 years after the initiation of antiparkinsonian medications. On the basis of the longitudinal trajectories of the LEDD increment, the participants were classified into three clusters: slow-increment, initial-increment, and rapid-increment. The outcomes were initial and longitudinal changes in motor phenotype, on-time motor symptoms, and the efficacy of antiparkinsonian medications.

Results: The initial-increment cluster exhibited the greatest symptomatic improvements following the administration of higher doses of LEDD, although the motor improvement per unit of LEDD was comparable across clusters. Longitudinally, motor phenotypes changed rapidly in the initial-increment cluster. The initial-increment cluster showed continuous worsening of on-time motor symptoms, with limited LEDD efficacy. In contrast, the rapid-increment cluster exhibited stable on-time motor symptoms, whereas the efficacy of antiparkinsonian medications declined over time. The risk of disability related to walking and balance milestones and motor complications was twice as high in the initial-increment and rapid-increment clusters than in the slow-increment cluster.

Conclusion: Heterogeneity is noted in the increase in the use of antiparkinsonian medications, which is driven by changes in motor phenotype, medication efficacy, and the occurrence of PD-relevant milestones. Subtyping patients on the basis of LEDD trajectories may provide insight into clinical heterogeneity for future research on individualized treatment strategies for patients with PD.

Objective: To investigate the cholinergic underpinnings of forward and retro-walking in patients with Parkinson's disease (PwP) using [18F]fluoroethoxybenzovesamicol ([18F]FEOBV) positron emission tomography (PET), which binds to the vesicular acetylcholine transporter.

Methods: We retrospectively included 44 PwP who underwent [18F]FEOBV PET imaging and forward- and retro-walking gait assessments. Voxelwise correlation analyses were performed to examine associations between gait velocities and [18F]FEOBV binding, controlling for levodopa equivalent dose and disease duration. Linear regression and mediation analyses were used to investigate the contribution of postural instability and gait disorder symptoms-measured using MDS-UPDRS items and the Mini-Balance Evaluation Systems Test (MiniBESTest)-as well as cognitive performance (attention, memory, executive, language, and visuospatial domains) to the observed associations.

Results: Slower retro-walking velocity was associated with lower [18F]FEOBV uptake in a subcortical-frontal-temporal cluster, including the bilateral middle frontal cortex, anterior cingulate, insula, basal forebrain, and striatal regions. No significant associations were found for forward walking time. Linear regression analyses revealed that MiniBESTest total score, reactive postural control subscore, and attention domain score were associated with both cholinergic uptake in the identified cluster and retro-walking velocities. Mediation analyses revealed that attention and reactive postural control mediated the relationship between [18F]FEOBV binding and retro-walking performance.

Conclusion: Our findings indicate that retro-walking places greater demands on brain cholinergic synaptic integrity involving subcortical-frontal and temporal cortical regions, subserving balance-particularly reactive postural control-and attentional resources compared to forward walking. Our results suggest that retro-walking might serve as part of an intervention strategy to improve balance and cognition in PwP.