Jane E Alty

Jane E Alty
University of Tasmania · Wicking Dementia Research and Education Centre

MA (Cantab.) MB BChir FRCP MD

About

93
Publications
22,704
Reads
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800
Citations
Additional affiliations
April 2013 - November 2015
Leeds Teaching Hospitals NHS Trust
Position
  • Consultant Neurologist
April 2013 - present
University of Leeds
Position
  • Honorary Senior Lecturer
August 2010 - September 2014
The University of York
Position
  • MD postgraduate degree
Description
  • MD thesis title 'Objective evaluation of Parkinson's disease bradykinesia'
Education
October 1994 - December 1999
University of Cambridge
Field of study
  • MA (Cantab.) MB BChir

Publications

Publications (93)
Article
Full-text available
Digital health technologies (DHTs) have great potential for use as clinical trial outcomes; however, practical issues need to be addressed in order to maximise their benefit. We describe our experience of incorporating two DHTs as secondary/exploratory outcome measures in PD STAT, a randomised clinical trial of simvastatin in people with Parkinson’...
Article
Full-text available
Background and objectives Studies of Functional Neurological Disorders (FND) are usually outpatient-based. To inform service development, we aimed to describe patient pathways through healthcare events, and factors affecting risk of emergency department (ED) reattendance, for people presenting acutely with FND. Methods Acute neurology/stroke teams...
Chapter
Parkinson’s disease is one of the most common neurological conditions whose symptoms are usually treated with a drug containing levodopa. To minimise levodopa side effects, i.e. levodopa-induced dyskinesia (LID), it is necessary to correctly manage levodopa dosage. This article covers an application of cartesian genetic programming (CGP) to assess...
Article
Full-text available
Parkinson’s disease (PD) is a progressive neurodegenerative disorder that causes abnormal movements and an array of other symptoms. An accurate PD diagnosis can be a challenging task as the signs and symptoms, particularly at an early stage, can be similar to other medical conditions or the physiological changes of normal ageing. This work aims to...
Article
Tomorrow’s doctors are unprepared to prevent dementia. This cross-sectional study invited medical students enrolled in the University of Tasmania 5-year medical degree (MBBS) to participate in an online questionnaire during 2019. This study measured students’ recall of risk factors, prompted and unprompted, for dementia and cardiovascular disease (...
Article
While upper limb reaches are often made in a feed-forward manner, visual feedback during the movement can be used to guide the reaching hand towards a target. In Parkinson's disease (PD), there is evidence that the utilisation of this visual feedback is increased. However, it is unclear if this is due solely to the characteristic slowness of moveme...
Article
A substantial proportion of risk for age‐related dementia may be attributable to modifiable factors. The ISLAND Project responds to international calls (Lancet Commission, World Health Organisation) to investigate the effectiveness of public health strategies for reducing dementia risk. This large longitudinal and interventional cohort study will e...
Article
Background Computer vision can measure movement from video without the time and access limitations of hospital accelerometry / electromyography, or the requirement to hold or strap a smartphone accelerometer. Objective To compare computer vision measurement of hand tremor frequency from smartphone video with a gold standard measure, accelerometer....
Article
Full-text available
Objectives: With few empirically supported treatments, functional movement disorders (FMD) can be challenging to manage. To enable service providers to better support people with FMD, this study sought to understand the lived experience of FMD: to gain insight into how individuals make sense of their experience from symptom onset through medical e...
Article
Background Slowness of movement, known as bradykinesia, is the core clinical sign of Parkinson's and fundamental to its diagnosis. Clinicians commonly assess bradykinesia by making a visual judgement of the patient tapping finger and thumb together repetitively. However, inter-rater agreement of expert assessments has been shown to be only moderate...
Article
Introduction Eulerian magnification amplifies very small movements in video, revealing otherwise invisible motion. This raises the possibility that it could enable clinician visualisation of subclinical tremor using a standard camera. We tested whether Eulerian magnification of apparently atremulous hands reveals a Parkinsonian tremor more frequent...
Article
Parkinson’s disease (PD) is a common neurodegenerative disease. Delayed administration of PD medications is associated with increased risk of life-threatening complications including choking, aspiration pneumonia and neuroleptic malignant syndrome. In 2016, the spouse of a patient with PD wrote to Leeds Teaching Hospitals Trust (LTHT) to highlight...
Conference Paper
Full-text available
Parkinson's disease is diagnosed based on expert clinical observation of movements. One important clinical feature is decrement, whereby the range of finger motion decreases over the course of the observation. This decrement has been assumed to be linear but has not been examined closely.We previously developed a method to extract a time series rep...
Article
Objective The worldwide prevalence of Parkinson's disease is increasing. There is urgent need for new tools to objectively measure the condition. Existing methods to record the cardinal motor feature of the condition, bradykinesia, using wearable sensors or smartphone apps have not reached large-scale, routine use. We evaluate new computer vision (...
Article
Ageing, genetic, medical and lifestyle factors contribute to the risk of Alzheimer’s disease and other dementias. Around a third of dementia cases are attributable to modifiable risk factors such as physical inactivity, smoking and hypertension. With the rising prevalence and lack of neuroprotective drugs, there is renewed focus on dementia prevent...
Article
Though John Ruskin (1819–1900) is remembered principally for his work as a theorist, art critic and historian of visual culture, he wrote exhaustively about his health in his correspondence and diaries. Ruskin was prone to recurring depressive and hypochondriacal feelings in his youth and adulthood. In 1871, at the age of 52 years, he developed an...
Conference Paper
Previous studies have proposed an objective non-invasive approach to assist diagnosing neurological diseases such as Alzheimer and Parkinson's diseases by asking patients to perform certain drawing tasks against certain figure. However, the approach of rating those drawing test results is still very subjective by relying on manual measurements. By...
Article
Multiple myeloma is a haematological malignancy with clonal plasma cell proliferation and production of monoclonal immunoglobulins. Its neurological complications are relatively common, caused by both the disease and the treatment. Neurologists should therefore be familiar with its neurological manifestations and complications. We describe a 40-yea...
Article
Both multiple system atrophy and Parkinson’s disease may present with parkinsonism and autonomic dysfunction. We describe a patient who initially met the diagnostic criteria for multiple system atrophy and had atypical features for Parkinson’s disease including blackouts and pyramidal signs. Ultimately, he was found to have three separate diagnoses...
Conference Paper
Full-text available
Slowness of movement, known as bradykinesia, is an important early symptom of Parkinson’s disease. This symptom is currently assessed subjectively by clinical experts. However, expert assessment has been shown to be subject to inter-rater variability. We propose a low-cost, contactless system using smartphone video to automatically determine the pr...
Poster
Objectives Functional neurological disorders are common, but there is a lack of objective tests for these conditions. Although accelerometry can distinguish functional from other tremor types, it is not routinely used at the bedside. Computer vision describes the processing of camera images by computer. It requires only ubiquitous hardware (e.g. sm...
Article
Objectives Cervical dystonia (CD) is known to be associated with depression and low quality of life (QoL) but we know little about these measures in non-CD patients attending botulinum toxin clinics. The objective was to evaluate the prevalence of depression and low QoL in both CD and nonCD patients. Design Cross-sectional pilot study. Subjects C...
Article
Objectives The geste antagoniste is a typical feature of dystonia’s motor phenomenology. Gestes may also occur in functional dystonia. We investigated how gestes affect the kinematics of voluntary movement. Design Cross-sectional study. Subjects Twenty-three patients with organic dystonia and three with functional dystonia were studied. Methods...
Article
Full-text available
Background There is an urgent need for developing objective, effective and convenient measurements to help clinicians accurately identify bradykinesia. The purpose of this study is to evaluate the accuracy of an objective approach assessing bradykinesia in finger tapping (FT) that uses evolutionary algorithms (EAs) and explore whether it can be use...
Poster
The core clinical feature of Parkinson’s disease is bradykinesia. However, the most common method of clinical assessment, finger tapping, has poor inter-rater reliability, even among movement disorder specialists. Many technologies have been devised to objectively measure finger tapping, but virtually all involve specialised equipment, which may ex...
Presentation
Full-text available
Introduction Patients with Functional Neurological Symptoms (FNS) can present acutely, but many hospitals lack specific pathways or services for them. Outpatient FNS cohorts have been studied, but there is little data regarding acute FNS to inform service improvement. Method Over an 8 month period at Leeds Teaching Hospitals NHS Trust (UK), the on...
Poster
Arthur C Clarke’s ‘third law’ states that any sufficiently advanced technology is indistinguishable from magic. Computer vision is the processing of images or video by computer to extract useful information. A technique termed ‘Eulerian magnification’ involves amplification of tiny movements from video recordings, so that very small motions can bec...
Article
Introduction: The long duration response to levodopa in Parkinson's disease outlasts drug elimination by days to weeks. Though a substantive part of anti-parkinsonian motor benefit, it cannot easily be observed. Objectives: To infer the magnitude of the long duration response during the first decade of Parkinson's disease and identify factors th...
Article
Full-text available
Jeremy Cosgrove, Jane Elizabeth Alty Department of Neurology, Leeds Teaching Hospitals NHS Trust, Leeds, UK Abstract: Cognitive dysfunction is a common and significant non-motor symptom of Parkinson’s disease (PD). PD mild cognitive impairment (PD-MCI) is evident in approximately one-quarter of patients at the time of PD diagnosis, and half of PD p...
Article
Full-text available
Parkinson’s disease (PD) is a neurodegenerative movement disorder. Although there is no cure, symptomatic treatments are available and can significantly improve quality of life. The motor, or movement, features of PD are caused by reduced production of the neurotransmitter dopamine. Dopamine deficiency is most often treated using dopamine replaceme...
Article
Full-text available
When a patient presents with tremor, it can be useful to perform a few simple pen and paper tests. In this article, we explain how to maximise the value of handwriting and of drawing Archimedes spirals and straight lines as clinical assessments. These tasks take a matter of seconds to complete but provide a wealth of information that supplements th...
Conference Paper
Directional changes (DC) is an event based encoding for time series data that has become popular in financial analysis, particularly within the evolutionary algorithm community. In this paper, we apply DC to a medical analytics problem, using it to identify and summarise the periods of opposing directional trends present within a set of acceleromet...
Conference Paper
Full-text available
Parkinson’s disease (PD) is a common and disabling condition without cure. An early and accurate diagnosis is important for monitoring the disease and managing symptoms. Over time, the majority of patients with PD develop cognitive impairment, which is diagnosed using global tests of cognitive function or more detailed neuropsychological assessment...
Article
Full-text available
Before 1911, when Hermann Oppenheim introduced the term dystonia, this movement disorder lacked a unifying descriptor. While words like epilepsy, apoplexy and palsy have had their meanings since antiquity, references to dystonia are much harder to identify in historical documents. Torticollis is an exception, though there is difficulty distinguishi...
Article
Full-text available
Transient amnestic syndromes are fascinating clinical entities and there are several subtypes. Transient global amnesia (TGA) is characterised by sudden onset of anterograde amnesia with repetitive questioning, lasting less than 24 hours. The pathophysiology of TGA involves the medial temporal lobes and hippocampi. Episodes of TGA are thought to in...
Conference Paper
Parkinson's disease is a progressive neurodegenera-tive disorder. The biggest risk factor for developing Parkinson's disease is age and so prevalence is increasing in countries where the average age of the population is rising. Cognitive problems are common in Parkinson's disease and identifying those with the condition who are most at risk of deve...
Article
Mind-brain dualism has dominated historical commentary on dystonia, a dichotomous approach that has left our conceptual grasp of it stubbornly incomplete. This is particularly true of functional dystonia, most diagnostically challenging of all functional movement disorders, in which the question of inherent psychogenicity remains a focus of debate....
Article
Bernard Blancard was a medieval scribe, a professional writer with legal and contract expertise, who worked in Marseille, France. His handwritten, dated records are remarkably extensive, spanning the years 1297 to 1343. Progressive writing anomalies in these documents suggest that he had a movement disorder. We formed a multidisciplinary team, incl...
Conference Paper
Full-text available
The incidence of neurodegenerative diseases such as Parkinson’s is increasing rapidly around the world, yet the symptoms and pathology of these diseases remain incompletely understood. As a consequence, it is challenging for clinicians to provide patients with accurate diagnoses or prognoses. In this work, we use multi-objective evolutionary algori...
Conference Paper
Full-text available
Parkinson's disease (PD) is a chronic neurodegenerative condition. Traditionally categorised as a movement disorder, nowadays it is recognised that PD can also lead to significant cognitive dysfunction including, in many cases, full-blown dementia. Due to the wide range of symptoms, including significant overlap with other neurodegenerative conditi...
Conference Paper
Objective: To evaluate a cohort of people with Parkinson’s disease (PD) who were initiated on subcutaneous apomorphine injections or continuous subcutaneous apomorphine infusions (CSAI) on a day case unit in a large UK teaching hospital. Background: Although there is extensive evidence for the efficacy of apomorphine in PD, there are no set guidel...
Conference Paper
Full-text available
Objective: To explore differences in kinematic parameters of reach in those with Parkinson’s disease (PD) classified into normal cognition (PD-NC), mild cognitive impairment (PD-MCI) and dementia (PDD). Background: Reaching is a motor action controlled by a highly specialised neural pathway involving the posterior parietal and premotor frontal cor...
Conference Paper
Full-text available
Objective: To test the hypothesis that simple reaction time (SRT) is associated with global cognition in Parkinson’s disease (PD) after controlling for motor function. Background: Cognitive impairment is a common non-motor feature of PD and identification of simple biomarkers to predict those most at risk of this is a highly desirable goal. SRT co...
Conference Paper
Full-text available
Objective: To assess whether MDS-UPDRS grade one Parkinson’s disease (PD) bradykinesia can be accurately detected by a novel non-invasive device that analyses a standard finger tapping (FT) clinical assessment using evolutionary computation methods. Background: Bradykinesia is the fundamental motor feature of PD but may be difficult to detect clin...
Conference Paper
Full-text available
Objective: To evaluate how accurately a new device can discriminate different clinical severities of dyskinesia from non-dyskinetic movements in patients with Parkinson's disease (PD). Background: PD dyskinesia is a leading cause of falls and unplanned hospital admissions and leads to reduced quality of life (QOL). It may occur unpredictably and fr...
Conference Paper
Full-text available
Objective: We evaluate the dated documents of a French scribe, which span the late 13th and early 14th centuries, in order to reach a diagnosis for his unusual handwriting. We review the differential diagnosis in the context of his 46-year-long and illustrious career. Background: Bernard Blancard was a medieval notary, a professional writer with l...
Article
Full-text available
Levodopa is a drug that is commonly used to treat movement disorders associated with Parkinson's disease. Its dosage requires careful monitoring, since the required amount changes over time, and excess dosage can lead to muscle spasms known as levodopa-induced dyskinesia. In this work, we investigate the potential for using epiNet, a novel artifici...
Article
Introduction: It is important to understand how the rate of motor progression in PD relates to dopaminergic treatment. Methods: The methods for this study comprised prospective defined off state measurements of the levodopa response at 3-year intervals over a mean 13.3-year period in 34 patients enrolled before treatment initiation. Results: D...
Article
People with Parkinson's disease have limited brain reserves of endogenous dopamine; thus, their medications must not be omitted or delayed as this may lead to a significant drop in brain dopamine levels. This has two main clinical consequences: first, a deterioration in disease control, with distressing symptoms such as tremor, pain, rigidity, dysp...
Article
Full-text available
Introduction Clock drawing (CD) requires executive function, attention and visuospatial ability. Our objective was to investigate CD in Parkinson's subjects with and without cognitive impairment. Methods 107 subjects completed the Montreal Cognitive Assessment (MoCA), classifying into normal cognition (PD-NC – MoCA ≥26) and cognitive impairment (PD...
Article
Full-text available
Objective To investigate separable components of finger tapping (FT) of the thumb and index finger in Parkinson's (PD) with normal (PD-NC) and impaired cognition (PD-CI) and in healthy controls (HC). Methods 58 PD and 29 HC performed FT for 30 seconds whilst attached to electromagnetic movement sensors sampling at 60 Hz. All subjects completed the...
Article
Full-text available
Objective To determine which test of visuospatial function – copying a wired cube (‘cube’) or interlocking pentagons (‘pentagons’) – is the best screening tool for detecting cognitive impairment in Parkinson's, as defined by abnormal Montreal Cognitive Assessment (MoCA) score. Methods 107 Parkinson's subjects completed the MoCA and copied pentagons...
Article
Full-text available
Sir, We thank Elan Louis for his interest in our article on the essential tremor of the medieval ‘Tremulous Hand of Worcester’. We are glad to receive his thoughtful comments in agreement with essential tremor as the most likely diagnosis. Unlike modern …
Article
Full-text available
OBJECTIVES: Patients with Parkinson’s disease are frequently treated with levodopa which treats stiffness and tremors. Many patients develop problems with involuntary movements called ‘dyskinesia’ as a result of levodopa medication. Levodopa-induced dyskinesia (LID) can be improved by adjusting the dosage to find a tolerable balance between the ben...
Article
BACKGROUND: Performance on figure copy tests has been shown to predict progressive cognitive decline in Parkinson's disease (PD). Historically, the interlocking pentagons from the Mini Mental State Exam (MMSE) have been the figure copy test most commonly used during cognitive screening evaluations. However, the wire cube from the Montreal Cognitiv...
Article
Full-text available
Scholars have recognized for some time that a prolific 13th century scribe had a tremor. He has become known as ‘the Tremulous Hand of Worcester’, or simply ‘the Tremulous Hand’, ‘hand’ being a metonym for ‘scribe’. He is important as the only widely-known medieval writer with a tremor, and for his unusual interest in translating documents written...
Article
This study describes how the application of evolutionary algorithms (EAs) can be used to study motor function in humans with Parkinson's disease (PD) and in animal models of PD. Human data is obtained using commercially available sensors via a range of non-invasive procedures that follow conventional clinical practice. EAs can then be used to class...
Article
Full-text available
Myopathies typically present with proximal or generalised muscle weakness, but it is important for clinicians to recognise they may also have other distributions. This paper describes a case of distal myopathy that was confirmed genetically as ZASP (Z-band alternatively spliced PDZ motif-containing protein) myofibrillar myopathy (MFM). MFMs are par...
Article
Full-text available
Cognitive impairment is a significant non-motor symptom of Parkinson's disease (PD). Longitudinal cohort studies have demonstrated that approximately 50% of those with PD develop dementia after 10 years, increasing to over 80% after 20 years. Deficits in cognition can be identified at the time of PD diagnosis in some patients and this mild cognitiv...
Data
Objective: To assess whether an accurate objective measurement of bradykinesia can be obtained from novel devices employing electromagnetic (EM) tracking sensors and a digitising tablet. Background: Bradykinesia is the fundamental clinical feature of Parkinson's disease (PD) and may often be the sole motor presentation in the early stages. Clinica...
Conference Paper
Full-text available
Objective: To evaluate how accurately a new non-invasive device can monitor dyskinesia in people with Parkinson's. Background: Dyskinesia is a common and troublesome adverse e of drugs used to treat Parkinson's and is associated with reduced quality of life. It may be reduced by altering the drug regimen times and dosages. However the presence and...
Conference Paper
Full-text available
Hypothesis: Subtle differences in reaching and grasping movements will differentiate people with Parkinson's dementia (PDD), people with Parkinson's with mild cognitive impairment (PD-MCI), people with Parkinson's with normal cognition (PD-NC) and healthy controls (HC). The changes in the PDD group are likely to be driven by deficits in visuospatia...
Conference Paper
Full-text available
Parkinson's disease is a chronic neurodegenerative condition that manifests clinically with various movement disorders. These are often treated with the dopamine-replacement drug levodopa. However, the dosage of levodopa must be kept as low as possible in order to avoid the drug's side effects, such as the involuntary, and often violent, muscle spa...
Conference Paper
Full-text available
Objective: To assess whether an accurate objective measurement of ‘slight’ (MDS-UPDRS grade one) bradykinesia can be obtained from a novel device employing electromagnetic (EM) tracking sensors and evolutionary algorithm analysis. Background: Bradykinesia is the fundamental clinical feature of Parkinson's disease (PD) but when very mild is diffic...
Article
Background: Parkinson's disease is a common, life-limiting, neurodegenerative condition. Despite calls for improved access to palliative care for people with Parkinson's disease, services have been slow in developing. Obstacles include poor understanding and recognition of palliative care needs, the role for specialist palliative care services and...
Chapter
Parkinson’s Disease is a devastating illness with no currently available cure. As the population ages, the disease becomes more common with a large financial cost to society. A rapid and accurate diagnosis, as well as practical monitoring meth- ods are essential for managing the disease as best as possible. This paper discusses two approaches...