Quantifying daily physical activity and determinants in sedentary patients with Parkinson's disease

BackgroundAlthough physical activity is beneficial for Parkinson's disease (PD) patients, many do not meet the recommended levels. The range of physical activity among sedentary PD patients is unknown, as are factors that determine this variability. Hence, we aimed to (1) assess daily physical activity in self-identified sedentary PD patients; (2) compare this with criteria of a daily physical activity guideline; and (3) identify determinants of daily physical activity.MethodsDaily physical activity of 586 self-identified sedentary PD patients was measured with a tri-axial accelerometer for seven consecutive days. Physical fitness and demographic, disease-specific, and psychological characteristics were assessed. Daily physical activity was compared with the 30-min activity guideline. A linear mixed-effects model was estimated to identify determinants of daily physical activity.ResultsAccelerometer data of 467 patients who fulfilled all criteria revealed that >98% of their day was spent on sedentary to light-intensity activities. Eighty-two percent of the participants were ‘physically inactive’ (0 days/week of 30-min activity); 17% were ‘semi-active’ (1–4 days/week of 30-min activity). Age, gender, physical fitness, and scores on the Unified Parkinson's Disease Rating Scale explained 69% of the variability in daily physical activity.ConclusionsPerformance-based measurements confirmed that most self-identified sedentary PD patients are ‘physically inactive’. However, the variance in daily physical activity across subjects was considerable. Higher age, being female, and lower physical capacity were the most important determinants of reduced daily physical activity. Future therapeutic interventions should aim to improve daily physical activity in these high-risk patients, focusing specifically on modifiable risk factors.     

A case study of an emerging visual artist with frontotemporal lobar degeneration and amyotrophic lateral sclerosis

Patients presenting with left-sided FTLD syndromes sometimes develop a new preoccupation with art, greater attention to visual stimuli, and increased visual creativity. We describe the case of a 53-year-old, right-handed man with a history of bipolar disorder who presented with language and behavior impairments characteristic of FTLD, then developed motor symptoms consistent with a second diagnosis of amyotrophic lateral sclerosis. Though the patient had never created visual art before, he developed a compulsion for painting beginning at the earliest stages of his disease, and continued producing art daily until he could no longer lift a paintbrush because of his motor deficits. Upon autopsy, he was found to have ubiquitin and TDP43-positive inclusions with MND pathology. This case study details the patient's longitudinal neuropsychological, emotional, behavioral, and motor symptoms, along with structural imaging, neurologic, and neuropathologic findings. Multiple examples of the patient's art are depicted throughout all stages of his illness, and the possible cognitive, behavioral, and neurologic correlates of his new-onset visual artistry are discussed.     

Musical anhedonia: Selective loss of emotional experience in listening to music

Recent case studies have suggested that emotion perception and emotional experience of music have independent cognitive processing. We report a patient who showed selective impairment of emotional experience only in listening to music, that is musical anhednia. A 71-year-old right-handed man developed an infarction in the right parietal lobe. He found himself unable to experience emotion in listening to music, even to which he had listened pleasantly before the illness. In neuropsychological assessments, his intellectual, memory, and constructional abilities were normal. Speech audiometry and recognition of environmental sounds were within normal limits. Neuromusicological assessments revealed no abnormality in the perception of elementary components of music, expression and emotion perception of music. Brain MRI identified the infarct lesion in the right inferior parietal lobule. These findings suggest that emotional experience of music could be selectively impaired without any disturbance of other musical, neuropsychological abilities. The right parietal lobe might participate in emotional experience in listening to music.     

A Mirror in the Mind: A Case of Visual Allaesthesia in Homonymous Hemianopia

We report the case of a 61-year-old female patient with intracranial bleeding in left parietal and parieto-temporal regions and a history of epilepsy and migraine. MR images showed lesions of the optic radiation, but primary visual cortical areas were intact. Perimetric testing revealed an incomplete right hemianopia. The patient claimed that visual percepts from her intact field were projected as “mirror images” into the hemianopic field. The illusory images were weak and sometimes difficult to detect, but focusing spatial attention on the “mirror” image increased its saliency. Drawings the patient made of her pseudo-hallucinations revealed that the illusions were lateral transpositions instead of mirror images of real objects. The illusions were tilted in clockwise direction and were never colored, although color discrimination was unimpaired in the patient's left hemifield. We quantified the characteristics of the pseudohallucinations in several experiments: The patient was asked to adjust the position, rotation angle, and size of a white test card in her blind field so that it corresponded with the illusory projection of a card of standard size and position that was presented in the intact field. The test card was compressed in horizontal size by 20% and positioned 17° visual angle to the right of the standard, shifted 1.5° upward or downward, and rotated in clockwise direction by 22.6° on average. Large objects in the intact field were projected incompletely into the blind area. Our patient's symptoms are similar to those reported in earlier case studies of visual allaesthesia. We hypothesize that the “mirror image” is induced by sparse input from contralesional V1 via the corpus callosum upstream of the lesion site and a lack of inhibition or hyperexcitability of ipsilesional early visual areas after deafferentation. The rotation of the illusions may be induced by the parietal lesions causing faulty co-ordinate computations, e.g., an inability to integrate visual and otholitic input.     

Atypical lateralisation in emotional prosody in men with schizotypy

Individuals high in schizotypy have been shown to reveal reduced lateralisation in verbal processing which may be influenced by an impaired left hemisphere performance. However, little is known about schizotypy and right hemisphere functions such as emotional perception. The present study focuses on atypical lateralisation in language and emotional prosody in Impulsive Non-conformity (IMP), a specific aspect of schizotypy. A total of 41 participants (20 females) performed a dichotic listening linguistic and emotional prosody task, which typically shows a right ear advantage (REA) and left ear advantage (LEA), respectively. A median split based on the IMP scale included in the Oxford-Liverpool Inventory of Feelings and Experiences was used to divide the sample into high and low scorers. The results revealed a selective reduction of the LEA in the prosody task in high-IMP males. Females high and low in IMP revealed typical lateralisation in both tasks. The results indicate that high-IMP males are especially prone to atypical lateralisation in emotional prosody, which parallels those findings in male patients with schizophrenia. The results suggest similarities in sex-specific atypical brain organisation between schizotypy and schizophrenia.     

Rapid eye movement sleep behavior disorder in treatment-naïve Parkinson disease patients

Objective

Rapid eye movement (REM) sleep behavior disorder (RBD) is a risk factor for dementia in Parkinson disease (PD) patients. The objectives of our study were to prospectively evaluate the frequency of RBD in a sample of treatment-naïve, newly diagnosed PD patients and compare sleep characteristics and cognition in RBD and non-RBD groups.

Methods

Fifty-seven newly diagnosed PD patients were consecutively recruited in a university medical center. All patients underwent two overnight polysomnography (PSG) sessions and were diagnosed with RBD according to the International Classification of Sleep Disorders, Second Revision criteria. Daytime sleepiness was measured in a multiple sleep latency test (MSLT). Cognition was assessed in a standard neuropsychologic examination.

Results

Seventeen PD patients (30%) met the criteria for RBD. The RBD patients and non-RBD patients did not significantly differ in mean age, gender ratio, disease duration, motor symptom subtype and severity, total sleep time, percentage of REM sleep, apnea–hypopnea index, mean oxygen saturation, and importantly cognitive performance. However, non-RBD patients had a significantly shorter mean daytime sleep latency than RBD patients (15 vs 18 min, respectively; P = .014).

Conclusion

A high frequency of RBD was found in our sample of 57 newly diagnosed PD patients. At this stage in the disease, RBD was not found to be associated with other sleep disorders or cognitive decline. Follow-up is needed to assess the risk for developing dementia in early-stage PD patients with RBD.     

Clinical markers of early nigrostriatal neurodegeneration in idiopathic rapid eye movement sleep behavior disorder

Background

Rapid eye movement sleep behavior disorder (RBD) is an early feature in α synucleinopathies and may precede other clinical manifestations of disease for several years. Olfactory dysfunction and mild motor abnormalities (MMAs) are highly prevalent in prodromal α synucleinopathies such as RBD and are suspected to be predictive neurodegenerative markers. Because both markers also are highly prevalent in the healthy elderly population, the discriminative value to detect an early neurodegenerative process is unclear.

Methods

We examined 28 patients with idiopathic RBD (iRBD) without manifest neurodegenerative disease to determine diagnostic accuracy of MMAs and olfactory dysfunction in identifying patients with early nigrostriatal degeneration in transcranial sonography (TCS) and ¹²³I-2β-carbomethoxy-3β-(4-iodophenyl)-N-(3-fluoropropyl)-nortropane single-photon emission computed tomography (¹²³I-FP-CIT-SPECT).

Results

Sixty-three percent of our participants showed MMAs which were strongly associated with abnormal TCS and ¹²³I-FP-CIT-SPECT findings. The discriminative value in detecting participants with early nigrostriatal degeneration was excellent (area under the receiver operating characteristic [ROC] curve, 0.84 [P ? .003] for TCS and 0.79 [P ? .066] for ¹²³I-FP-CIT-SPECT). Olfactory dysfunction was present in 78% of iRBD participants, but it was not linked with neuroimaging abnormalities or MMAs. Olfactory dysfunction did not discriminate participants with early nigrostriatal degeneration (area under the ROC curve, 0.54 [P ? .747] for TCS and 0.31 [P ? .225] for ¹²³I-FP-CIT-SPECT). Early RBD manifestation but no demographic (e.g., age, gender) or clinical characteristics of RBD (e.g., duration, severity of RBD) were associated with neuroimaging abnormalities in TCS and ¹²³I-FP-CIT-SPECT.

Conclusions

Unlike olfactory dysfunction, MMAs discriminate patients with early nigrostriatal degeneration in iRBD. Early RBD manifestation seems to be an additional risk factor which aggravates neurodegenerative risk.     

Behavioral parent training to address sleep disturbances in young children with autism spectrum disorder: a pilot trial

Objectives

A large percentage of children with autism spectrum disorders (ASD) have bedtime and sleep disturbances. However, the treatment of these disturbances has been understudied. The purpose of our study was to develop a manualized behavioral parent training (BPT) program for parents of young children with ASD and sleep disturbances and to test the feasibility, fidelity, and initial efficacy of the treatment in a small randomized controlled trial (RCT).

Participants and methods

Parents of a sample of 40 young children diagnosed with ASD with an average age of 3.5 years were enrolled in our study. Participants were randomized to either the BPT program group or a comparison group who were given nonsleep-related parent education. Each participant was individually administered a 5-session program delivered over the 8-week study. Outcome measures of feasibility, fidelity, and efficacy were collected at weeks 4 and 8 after the baseline time point. Children’s sleep was assessed by parent report and objectively by actigraphy.

Results

Of the 20 participants in each group, data were available for 15 participants randomized to BPT and 18 participants randomized to the comparison condition. Results supported the feasibility of the manualized parent training program and the comparison program. Treatment fidelity was high for both groups. The BPT program group significantly improved more than the comparison group based on the primary sleep outcome of parent report. There were no objective changes in sleep detected by actigraphy.

Conclusions

Our study is one of few RCTs of a BPT program to specifically target sleep disturbances in a well-characterized sample of young children with ASD and to demonstrate the feasibility of the approach. Initial efficacy favored the BPT program over the comparison group and suggested that this manualized parent training approach is worthy of further examination of the efficacy within a larger RCT.