Movement Disorders Clinical Practice最新文献

Background: Transcranial direct current stimulation (tDCS) over the supplementary motor area (SMA) has shown promise in Tourette syndrome (TS), but previous studies were limited in size and stimulation duration.

Objective: The aim was to explore the efficacy and safety of multiple sessions of cathodal tDCS over the bilateral SMA on tic severity in TS.

Methods: A double-blind, randomized, sham-controlled trial 1 mA cathodal tDCS over bilateral SMA was performed in participants with TS older than 16 years. The intervention involved two 20-min periods of stimulation with either sham or active tDCS per day, over 5 consecutive days, during which participants actively suppressed tics. Tic severity was measured using the Yale Global Tic Severity Scale Total Tic Severity (YGTSS-TTS, primary outcome) score at baseline, day 5 (visit 5), and 1 week later (visit 6). Questionnaires focusing on comorbidities were performed at baseline and visit 6.

Results: Twenty-four participants were randomly assigned (12 active, 12 sham; 8 women; median age: 26). We observed a significant effect of visit on YGTSS-TSS, but no significant effect of treatment or treatment × visit interaction emerged. In contrast, a statistically significant effect of the treatment × visit interaction was observed for the motor tic subscore, with significantly larger improvement in the active arm. Furthermore, we detected a significantly larger decrease in premonitory urge intensity at visit 6 after active stimulation. No effect was detected on severity of comorbidities.

Conclusions: This preliminary study suggests that bilateral tDCS over the SMA provides small, but significant benefits in reducing motor tic severity in TS.

Background: People living with Parkinson's disease (PD) commonly experience heat sensitivity-worsening symptoms and restricted daily activities in heat.

Objective: This study aimed to develop a scale of heat sensitivity for people with PD.

Methods: Through a search of the scientific literature and online forums, we developed 41 items relating to experiences of heat for people with PD to assess heat sensitivity. A panel of experts was then consulted to review the scale items critically. After two rounds of review, the scale was refined to 36 items with an overall scale content validity index of 0.89. Via an online survey, 247 people with PD responded to the items.

Results: The items were examined with exploratory factor analysis to determine the underlying factors therein. After several iterations, a simple structure was achieved with 29 items loading uniquely onto one of four factors: daily activities, sweating and exercise, heat-related illness, and symptoms and medications. The model had acceptable to excellent fit statistics (root mean square error of approximation = 0.073 [90% confidence interval 0.067-0.081], root mean square of the residuals = 0.03, comparative fit index = 0.93, and Tucker-Lewis index = 0.91), and each factor showed high reliability (Cronbach's α ≥0.89). Factor and total scale scores were significantly higher among those reporting sensitivity to heat and poor health status.

Conclusion: This new heat sensitivity scale for people living with PD can enable health professionals and clients to assess the severity and impact of heat sensitivity.

Background: Dexterous dysfunction is a bothersome patient-reported symptom of Parkinson's disease (PD). Current clinical assessments do not directly evaluate goal-directed hand function. This project sought to determine the capability of the electronic Manual Dexterity Test (MDT) to characterize dexterity across a range of PD patients.

Objectives: To objectively quantify manual dexterity in individuals with PD using a self-administered manual dexterity test.

Methods: Two hundred and forty-nine PD patients completed trials of the MDT with each upper extremity (UE) both while ON and OFF antiparkinsonian medication. Differences in MDT by medication state, more vs less affected UE, and Hoehn and Yahr (H&Y) stage were evaluated using linear mixed models. The relationships of trial duration to MDS-UPDRS II patient quality of life (QoL) questions for eating, dressing and hygiene were also evaluated.

Results: MDT duration was significantly shorter ON medication (26.3 seconds) compared to OFF medication (27.2 seconds) (P < 0.001). Similarly, MDT duration was significantly shorter for less (25.8 seconds) compared to more (27.6 seconds) affected limb (P < 0.001). Trial durations increased with H&Y stage (P < 0.001 for trend). MDT performance was related to MDS-UPDRS II questions for eating, dressing, and hygiene performance (P < 0.001).

Conclusions: The MDT provides an objective and quantitative assessment of dexterity. The time to complete the MDT was sensitive to changes in medication state, more and less affected UE, disease severity, and important activities of daily living. The MDT has potential for utilization in precise tracking of manual dexterity over the course of PD.

Background: Depression is the most common psychiatric disorder diagnosed in patients with Parkinson's disease (PD). A direct role in PD depression for loss of dopaminergic terminals and dopamine-transporter (DAT) expression in the striatum is revealed by many studies.

Objectives: The objective was to discern the relationship between DAT neuroimaging and risk of depression in PD.

Methods: One hundred and ninety-eight PD patients (101 with depression, 97 without depression) were evaluated using an extensive protocol from 2015 to 2023. DAT availability at striatal terminals was assessed with single-photon emission computed tomography with ¹²³I-Ioflupane. Specific binding ratio (SBR) of ¹²³I-Ioflupane and the whole striatum asymmetry index (SASI) were calculated. Data were analyzed with univariate/multivariate models as well as receiver operating characteristic (ROC) curves.

Results: A logistic regression model adjusting for confounding risk factors of depression indicates that SASI and PD duration are associated with the odds of having parkinsonian depression. SASI is the strongest predictor of risk of parkinsonian depression. Following ROC analysis, SASI is found to be an accurate factor for detecting parkinsonian depression because a cutoff value of 3.4895 of SASI shows good accuracy (0.813), sensitivity (81.1%), and specificity (80%). Higher SASI is also linked to more disease-related limitations in activities of daily living.

Conclusion: The whole SASI is the strongest predictor of risk of parkinsonian depression. The findings could be valuable in evaluating depression in PD patients.

Background: Dexterity impairments are common among people with Parkinson's disease (PWP), yet little is understood about the effect of upper-limb (UL) dysfunction on daily activity performance.

Objectives: The aims were to (1) map the dexterity activities most affected and meaningful to PWP; (2) explore the associations between perceived dexterity function and disease severity, cognitive and motor UL impairments, dexterity ability, self-reported activities of daily living (ADL) function, and quality of life (QOL); (3) investigate variables explaining perceived dexterity function; and (4) examine the differences in perceived dexterity function based on dominance affectedness.

Methods: A total of 43 PWP (mean age = 70.00 years, standard deviation [SD] = 6.75) were assessed for perceived dexterity function (36-item Dexterity Questionnaire [DextQ-36]), dexterity ability (Coin Rotation Task), disease severity (modified Hoen and Yahr Scale), self-reported ADL function and motor UL impairments (Movement Disorder Society-Unified Parkinson's Disease Rating Scale), cognition (Montreal Cognitive Assessment), and QOL (Parkinson's Disease Questionnaire-39).

Results: The leading dexterity activities participants reported as difficult and meaningful included using a touchscreen, pulling on socks, and dialing a phone. Perceived dexterity significantly correlated with self-reported ADL function (r = 0.716), QOL (r = 0.691), disease severity (r = 0.470), and dominant-hand dexterity (r = 0.432). Dexterity ability and disease severity explained 30% of perceived dexterity variance. No differences in perceived dexterity function based on dominance affectedness were found.

Conclusions: PWP encounter challenges in complex dexterity tasks that impact their independence. Before interventions focused on UL function are initiated, assessments of PWP should include inquiries about the meaningfulness of challenging dexterity activities.

Background: Few studies have examined the effectiveness and duration of mindfulness-based therapies for tics in Tourette's syndrome. This study combined habit reversal therapy (HRT) with acceptance and commitment therapy (ACT).

Objectives: To evaluate the efficacy and response duration of HRT + ACT in reducing tic severity in adults with Tourette's Syndrome.

Methods: Tic severity was assessed at baseline, post-intervention, and at 6- and 12-month follow-ups using the Yale Global Tic Severity Scale (YGTSS) and video assessments. The intervention included eight weekly 1-h sessions.

Results: Mixed-effects regression showed significant reductions in tic severity post-treatment (b = -10.36, P = 0.002), maintained at 6 months (b = -8.19, P = 0.012) and 12 months (b = -8.82, P = 0.009). Video assessments confirmed these findings.

Conclusion: The HRT + ACT protocol effectively reduced tic severity, with benefits lasting 12 months. These results support further trials to compare HRT + ACT with HRT alone.

Background: Preferences for risk disclosure in population-based studies assessing Parkinson's disease (PD) risk have not been assessed so far.

Objectives: To examine preferences for risk disclosure in a subset of the European Healthy Brain Aging (HeBA) multicenter study.

Methods: After a remote PD risk assessment, a structured pilot-questionnaire on risk disclosure was first presented to participants (≥50 years, without neurodegenerative diseases) during in-person visits at the Innsbruck study site.

Results: From the included 81 participants (63% females, median age 65 years), 79% expressed an unconditional desire to be informed about their PD risk. Confronted with a hypothetical scenario of a positive, specific PD test, most would try to live a healthier lifestyle. Regarding future placebo-controlled disease-modification trials, 66% stated they would probably or definitely participate.

Conclusions: This pilot-study shows an open-minded view of participants towards disclosure of risk for future PD and a proactive attitude regarding dealing with one's risk.