Distal motor deficit contributions to postural instability and gait disorder in Parkinson's disease

被引:24
作者
Vervoort, Griet [1 ]
Bengevoord, Aniek [1 ,2 ]
Nackaerts, Evelien [1 ]
Heremans, Elke [1 ]
Vandenberghe, Wim [3 ]
Nieuwboer, Alice [1 ]
机构
[1] Katholieke Univ Leuven, Dept Rehabil Sci, Leuven, Belgium
[2] Radboud Univ Nijmegen, Med Ctr, NL-6525 ED Nijmegen, Netherlands
[3] Univ Hosp Leuven, Dept Neurol, Leuven, Belgium
关键词
Parkinson's disease; Clinical subtype; Motor control; COGNITIVE IMPAIRMENT; SUBTYPES; COORDINATION; TREMOR; HETEROGENEITY; DENERVATION; VARIABILITY; DYSFUNCTION; DISTURBANCE; DEMENTIA;
D O I
10.1016/j.bbr.2015.03.026
中图分类号
B84 [心理学]; C [社会科学总论]; Q98 [人类学];
学科分类号
03 ; 0303 ; 030303 ; 04 ; 0402 ;
摘要
Clinical subtypes in Parkinson's disease (PD) are often based on the presence of clustered motor symptoms. In contrast to the tremor dominant (TD) subtype, the postural instability and gait disorder (PIGD) subtype is characterized by predominantly axial motor involvement and increased cognitive impairment. It is, however, unclear if subtypes represent distinct underlying neuropathological mechanisms or reflect more severe disease progression. We aimed to clarify the validity of PD subtypes by investigating behavioral outcomes at multiple levels. Therefore, spatiotemporal kinematics of gait, upper and lower limb repetitive movements in combination with a balance and cognitive assessment were recorded in 73 patients with PD. We classified patients as PIGD (n = 43), TD (n = 22) or indeterminate (n = 8) while 'off' medication and recruited 20 age-matched controls. Surprisingly, differences between PIGD and TD were more prominent during repetitive distal motor tasks than during gait. Gait impairment in PIGD was only shown by reduced step length and gait speed. However, motor scaling and coordination of distal movements were more affected in PIGD than in TD patients. PIGD patients also had impaired postural control compared to TD patients as shown by lower mini-BESTest scores. There were no cognitive differences between patient subgroups. Distal movement was not significantly different in TD patients from controls, except for greater movement asymmetry. The results indicate a widespread impairment within PIGD with more pronounced distal than axial motor deficits. This suggests involvement of different neurotransmitter systems in the neuropathology of PD subtypes, which are at least partially independent of disease progression. (C) 2015 Elsevier B.V. All rights reserved.
引用
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页码:1 / 7
页数:7
相关论文
共 43 条
[1]  
Almeida QJ, 2002, MOVEMENT DISORD, V17, P30, DOI 10.1002/mds.10030
[2]   Changes in motor subtype and risk for incident dementia in Parkinson's disease [J].
Alves, Guido ;
Petter Larsen, Jan ;
Emre, Murat ;
Wentzel-Larsen, Tore ;
Aarsland, Dag .
MOVEMENT DISORDERS, 2006, 21 (08) :1123-1130
[3]   Cerebrospinal fluid amyloid-β and phenotypic heterogeneity in de novo Parkinson's disease [J].
Alves, Guido ;
Pedersen, Kenn Freddy ;
Bloem, Bastiaan R. ;
Blennow, Kaj ;
Zetterberg, Henrik ;
Borm, George F. ;
Dalaker, Turi O. ;
Beyer, Mona K. ;
Aarsland, Dag ;
Andreasson, Ulf ;
Lange, Johannes ;
Tysnes, Ole-Bjorn ;
Zivadinov, Robert ;
Larsen, Jan Petter .
JOURNAL OF NEUROLOGY NEUROSURGERY AND PSYCHIATRY, 2013, 84 (05) :537-543
[4]   Ten year survival and outcomes in a prospective cohort of new onset Chinese Parkinson's disease patients [J].
Auyeung, Man ;
Tsoi, T. H. ;
Mok, Vincent ;
Cheung, C. M. ;
Lee, C. N. ;
Li, R. ;
Yeung, E. .
JOURNAL OF NEUROLOGY NEUROSURGERY AND PSYCHIATRY, 2012, 83 (06) :607-611
[5]   Marked alterations in the gait timing and rhythmicity of patients with de novo Parkinson's disease [J].
Baltadjieva, Rossitza ;
Giladi, Nir ;
Gruendlinger, Leor ;
Peretz, Chava ;
Hausdorff, Jeffrey M. .
EUROPEAN JOURNAL OF NEUROSCIENCE, 2006, 24 (06) :1815-1820
[6]   Gait and upper limb variability in Parkinson's disease patients with and without freezing of gait [J].
Barbe, Michael T. ;
Amarell, Martin ;
Snijders, Anke H. ;
Florin, Esther ;
Quatuor, Eva-Lotte ;
Schoenau, Eckhard ;
Fink, Gereon R. ;
Bloem, Bastiaan R. ;
Timmermann, Lars .
JOURNAL OF NEUROLOGY, 2014, 261 (02) :330-342
[7]   DOPA-SENSITIVE AND DOPA-RESISTANT GAIT PARAMETERS IN PARKINSONS-DISEASE [J].
BLIN, O ;
FERRANDEZ, AM ;
PAILHOUS, J ;
SERRATRICE, G .
JOURNAL OF THE NEUROLOGICAL SCIENCES, 1991, 103 (01) :51-54
[8]   Gait speed in Parkinson disease correlates with cholinergic degeneration [J].
Bohnen, Nicolaas I. ;
Frey, Kirk A. ;
Studenski, Stephanie ;
Kotagal, Vikas ;
Koeppe, Robert A. ;
Scott, Peter J. H. ;
Albin, Roger L. ;
Mueller, Martijn L. T. M. .
NEUROLOGY, 2013, 81 (18) :1611-1616
[9]   Leucoaraiosis, nigrostriatal denervation and motor symptoms in Parkinson's disease [J].
Bohnen, Nicolaas I. ;
Mueller, Martijn L. T. M. ;
Zarzhevsky, Natalia ;
Koeppe, Robert A. ;
Bogan, Christopher W. ;
Kilbourn, Michael R. ;
Frey, Kirk A. ;
Albin, Roger L. .
BRAIN, 2011, 134 :2358-2365
[10]   Cholinergic denervation occurs early in Parkinson disease [J].
Bohnen, Nicolaas I. ;
Albin, Roger L. .
NEUROLOGY, 2009, 73 (04) :256-257