Twenty-one patients with Parkinson's disease were studied before and 2 h after the administration of a single dose of 20 mg of methylphenidate. In response to methylphenidate, attention significantly improved, whereas memory and visual-spatial performance were unchanged. Gait speed, stride time variability, and Timed Up and Go times (demonstrated measures of fall risk) significantly improved. These findings suggest a new potential pharmacologic means of enhancing mobility and decreasing fall risk in Parkinson's disease.
"A global cognitive score based on the average across the memory, executive function, attention, and motor skills measures was also determined using this battery   . These tests were previously used to assess cognitive function in patients with PD in cross-sectional studies [16, 36, 53, 65–67] and have also been responsive to interventions in PD  . "
[Show abstract][Hide abstract] ABSTRACT: Background.Cognitive function is generally evaluated based on testing in the clinic, but this may not always reflect real-life function. We tested whether parameters derived from long-term, continuous monitoring of gait are associated with cognitive function in patients with Parkinson’s disease (PD).
Methods. 107 patients with PD (age: 64.9 ± 9.3 yrs; UPDRS motor sum “off”: 40.4 ± 13.2; 25.23% women) wore a 3D accelerometer on their lower back for 3 days. Computerized measures of global cognitive function, executive function, attention, and nonverbal memory were assessed. Three-day acceleration derived measures included cadence, variability, bilateral coordination, and dynamic postural control. Associations between the acceleration derived measures and cognitive function were determined.
Results. Linear regression showed associations between vertical gait variability and cadence and between global cognitive score, attention, and executive function (𝑝 ≤ 0.048). Dynamic postural control was associated with global cognitive score and attention (𝑝 ≤ 0.027). Nonverbal memory was not associated with the acceleration-derived measures.
Conclusions. These findings suggest that metrics derived from a 3-day worn body-fixed sensor reflect cognitive function, further supporting the idea that the gait patternmay be altered as cognition declines and that gait provides a windowinto cognitive function
in patients with PD.
Journal of Parkinson's Disease 10/2015; DOI:10.1155/2015/547065 · 1.91 Impact Factor
"halamus with primary motor cortex and hippocampus ( Xia et al . , 2012 ) . Patients with Parkinson ' s disease ( PD ) demonstrate altered cortical and subcortical activation and functional connectivity ( Eidelberg et al . , 1994 ; Huang et al . , 2007 ; Ma and Eidelberg , 2007 ) . Low doses of methylphenidate improved gait and voluntary movement ( Auriel et al . , 2006 ; Devos et al . , 2007 ; Kwak et al . , 2010 ) , and along with levodopa improved performance on complex hand movements ( Nutt et al . , 2004 ) in patients with PD . In an earlier study , adding methylphenidate to levodopa treatment increased peak hand tapping speed in patients with PD compared to levodopa alone Table 2 . Summary of sig"
[Show abstract][Hide abstract] ABSTRACT: By blocking dopamine and norepinephrine transporters, methylphenidate affects cognitive performance and regional brain activation in healthy individuals as well as those with neuropsychiatric disorders. Resting-state connectivity evaluates the functional integrity of a network of brain regions. Here, we examined how methylphenidate effects resting-state functional connectivity of the dorsal striatum and thalamus, areas each with dense dopaminergic and noradrenergic innervations, as well as global cerebral connectivity. We administered a single, oral dose (45 mg) to 24 healthy adults and compared resting-state connectivity to 24 demographically matched adults who did not receive any medication. The results showed that methylphenidate alters seed-based and global connectivity between the thalamus/dorsal striatum with primary motor cortex, amygdala/hippocampus and frontal executive areas (p < 0.05, corrected). Specifically, while methylphenidate at this dosage enhances connectivity to the motor cortex and memory circuits, it dampens prefrontal cortical connectivity perhaps by increasing catecholaminergic signalling past the 'optimal' level. These findings advance our understanding of a critical aspect of the multifaceted effects of methylphenidate on brain functions. The results may also facilitate future studies of the aetiology and treatment of neurological and psychiatric disorders that implicate catecholaminergic dysfunction.
The International Journal of Neuropsychopharmacology 05/2014; 17(08):1-15. DOI:10.1017/S1461145714000674 · 4.01 Impact Factor
"Alternatively, perhaps, the magnitude of the cognitive change needed to affect on the TUG and straight line walking are not the same. In a previous study that examined the effects of methylphenidate in PD, gait speed, TUG and executive function all significantly improved . Perhaps the pharmacologic intervention had a more widespread or more potent effect. "
[Show abstract][Hide abstract] ABSTRACT: Background: Patients with Parkinson's disease (PD) suffer from impaired gait and mobility. These changes in motor function have been associated with cognitive deficits that also commonly co-occur in PD, especially executive function (EF) and attention. Objective: We hypothesized that a cognitive remediation program would enhance gait and mobility. Methods: The 18 PD patients in this study were assessed at baseline and again at one and four weeks after completion of a 12 week long, home-based computerized cognitive training program. Subjects were asked to "play" computer games designed to improve EF and attention for 30 minutes a day, three times per week for 12 weeks, while seated. The Timed Up and Go (TUG), gait speed, and stride time variability quantified mobility. A previously validated, computerized neuropsychology battery quantified global cognitive function and its sub-domains. Results: Compared to pre-training values, global cognitive scores and time to complete the TUG significantly improved after the training. TUG components of turning speed and duration also improved. Other TUG components, gait speed, and variability did not change after training. Conclusions: These initial findings suggest that computerized cognitive training can improve cognitive function and has a beneficial carryover effect to certain aspects of mobility in patients with PD. Additional studies are required to replicate these findings and more fully assess the underlying mechanisms. Nonetheless, the present results underscore the motor-cognitive link in PD and suggest that computerized cognitive training may be applied as a therapeutic option to enhance mobility in patients with PD.
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