Purpose. As the most frequent and earliest type of psychotic phenomenon in Parkinsons disease (PD), minor hallucination (MH) can occur before the onset of motor symptoms. This sensation may be an early predictor of severe psychotic and cognitive states and is often overlooked in clinics. This study was aimed at providing a comprehensive and in-depth understanding of MHs. Patients and Methods. Demographic information was obtained from 262 patients with PD, and a series of clinical assessment questionnaires were provided. According to the result of the Movement Disorders Society Unified Parkinsons Disease Rating Scale Part I, the patients were classified into the MH and nonhallucination (NH) groups. Results. MHs were the most common psychotic symptom with 38.9 prevalence. The most frequent MH was visual illusion, especially object misidentification. Three minor phenomena were somewhat consistent in terms of external factors, temporal factors, and content. Disease duration, daily levodopa equivalent dose, and percentage of levodopa and dopamine-receptor agonist use were remarkably greater in the MH group than in the NH group. After covariate control, the MH group had worse life quality and more severe nonmotor symptoms, including poor sleep quality and rapid eye movement sleep behavior disorder (RBD), than the NH group. The binary logistic regression model showed that RBD, sleep quality, and health-related life quality were associated with MHs. Conclusion. A high prevalence of MHs was observed in patients with PD. Further studies are needed to confirm and expand the identified clinical factors related to MH, which have potential prognostic and therapeutic implication.
Background. Previous studies found levodopa could improve the activity of the ankle joints of patients with Parkinson’s disease (PD). But ankle joint movement is composed of four motion ranges. The specific changes of four motion ranges in PD remain unknown. Objective. The purpose of this study was to decompose the complex ankle joint movement, measure ankle joint changes before and after the acute levodopa challenge test (ALCT), and investigate the effects of these parameters on gait performance. Methods. 29 PD patients and 30 healthy control subjects (HC) completed the Instrumented Stand and Walk (ISAW) test and gait parameters were collected by the JiBuEn gait analysis system. The percentage of improvement of gait data and the UPDRS III in the on-drug condition (ON) were determined with respect to the off-drug condition (OFF). Results. We observed a reduction in the heel strike angle (HS), 3-plantarflexion (3-PF) angle, and 4-dorsiflexion (4-DF) angle of ankle joints. We did not find significant difference in the toe-off angle (TO), 1-plantarflexion (1-PF) angle, and 2-dorsiflexion (2-DF) angle among three groups. Stride length improvement rate was significantly correlated with HS (rs = 0.616, ) and 3-PF (rs = 0.639, ) improvement rates. The improvement in the sum of rigidity items (UPDRS motor subsection item 22) was also correlated with HS (rs = 0.389, ) and 3-PF (rs = 0.373, ) improvement rates. Conclusions. Exogenous levodopa supplementation can significantly reduce the rigidity of patients with PD, improve their 3-PF and 4-DF of ankle joint kinematic parameters, and ultimately enhance their gait.
Objective: To quantify bradykinesia in Parkinson's disease (PD) with a Kinect depth camera-based motion analysis system and to compare PD and healthy control (HC) subjects. Methods: Fifty PD patients and twenty-five HCs were recruited. The Movement Disorder Society-Sponsored Revision of the Unified Parkinson's Disease Rating Scale part III (MDS-UPDRS III) was used to evaluate the motor symptoms of PD. Kinematic features of five bradykinesia-related motor tasks were collected using Kinect depth camera. Then, kinematic features were correlated with the clinical scales and compared between groups. Results: Significant correlations were found between kinematic features and clinical scales ( P < 0.05). Compared with HCs, PD patients exhibited a significant decrease in the frequency of finger tapping ( P < 0.001), hand movement ( P < 0.001), hand pronation-supination movements ( P = 0.005), and leg agility ( P = 0.003). Meanwhile, PD patients had a significant decrease in the speed of hand movements ( P = 0.003) and toe tapping ( P < 0.001) compared with HCs. Several kinematic features exhibited potential diagnostic value in distinguishing PD from HCs with area under the curve (AUC) ranging from 0.684–0.894 ( P < 0.05). Furthermore, the combination of motor tasks exhibited the best diagnostic value with the highest AUC of 0.955 (95% CI = 0.913–0.997, P < 0.001). Conclusion: The Kinect-based motion analysis system can be applied to evaluate bradykinesia in PD. Kinematic features can be used to differentiate PD patients from HCs and combining kinematic features from different motor tasks can significantly improve the diagnostic value.
Gait disturbance is a prototypical feature of Parkinson’s disease (PD), and the quantification of gait using wearable sensors is promising. This study aimed to identify gait impairment in the early and progressive stages of PD according to the Hoehn and Yahr (H–Y) scale. A total of 138 PD patients and 56 healthy controls (HCs) were included in our research. We collected gait parameters using the JiBuEn gait-analysis system. For spatiotemporal gait parameters and kinematic gait parameters, we observed significant differences in stride length (SL), gait velocity, the variability of SL, heel strike angle, and the range of motion (ROM) of the ankle, knee, and hip joints between HCs and PD patients in H–Y Ⅰ-Ⅱ. The changes worsened with the progression of PD. The differences in the asymmetry index of the SL and ROM of the hip were found between HCs and patients in H–Y Ⅳ. Additionally, these gait parameters were significantly associated with Unified Parkinson’s Disease Rating Scale and Parkinson’s Disease Questionnaire-39. This study demonstrated that gait impairment occurs in the early stage of PD and deteriorates with the progression of the disease. The gait parameters mentioned above may help to detect PD earlier and assess the progression of PD.
Background and Purpose. Patients with early-stage Parkinson’s disease (PD) have gait impairments, and gait parameters may act as diagnostic biomarkers. We aimed to (1) comprehensively quantify gait impairments in early-stage PD and (2) evaluate the diagnostic value of gait parameters for early-stage PD. Methods. 32 patients with early-stage PD and 30 healthy control subjects (HC) were enrolled. All participants completed the instrumented stand and walk test, and gait data was collected using wearable sensors. Results. We observed increased variability of stride length (SL) ( ), stance phase time (StPT) ( ), and swing phase time (SwPT) ( ) in PD. There were decreased heel strike (HS) ( ), range of motion of knee ( ), and hip joints ( ) in PD. In symmetry analysis, no difference was found in any of the assessed gait parameters between HC and PD. Only total steps ( , ), SL ( , ), SL variability ( , ), StPT variability ( , ), and SwPT variability (
1 October 2020 in Neuropsychiatric Disease and Treatment
Purpose: Gait impairment is a common clinical symptom of patients with Parkinson’s disease (PD). Detecting specific gait parameters’ changes in order to guide clinical intervention is at present lacking. The present study aimed to (1) quantify gait impairments in different PD subtypes and (2) explore whether the results of quantitative gait analysis are beneficial to clinical treatment. Patients and Methods: We enrolled 86 patients with PD (48 men, and 38 women) from the Department of Geriatrics of the Affiliated Brain Hospital of Nanjing Medical University. Unified Parkinson’s Disease Rating Scale (UPDRS) and Hoehn-Yahr Scale were used to evaluate the motor symptoms of PD. All patients stopped anti-Parkinsonian medication for 24 hours (72 hours for controlled release medicine). The patients were divided into two subtypes, namely, postural instability gait difficulty (PIGD; n=56) and tremor dominant (TD; n=30) subtypes according to UPDRS. All patients completed the instrumented stand and walk test, and a set of JiBuEn gait analysis system was used in gait data collection. Results: We observed a shorter stride length (p=0.021), a longer stride time (p=0.036), a faster cadence (p=0.036), and a more variable stride length (p=0.012) in the PIGD group compared with the TD group. In addition, compared with the TD group, we found that the toe-off angle (p=0.005) and the range of motion of ankle joint (p=0.009) decreased in the PIGD group. Conclusion: Our study demonstrated that the gait performance of patients with PIGD is worse than those with TD from the perspective of quantitative gait analysis. We extended previous research and found the PIGD group exhibited severe gait impairments in some specific spatiotemporal and kinematic gait parameters. The different manifestations of these gait impairments may guide in choosing appropriate treatment of patients with different PD subtypes.