1. Dynamic balance and gait impairments in Parkinson’s disease : novel cholinergic patternsNicolaas I. Bohnen, Uroš Marušič, Stiven Roytman, Rebecca Paalanen, Fotini Michalakis, Taylor Brown, Peter J. H. Scott, Giulia Carli, Roger Albin, Prabesh Kanel, 2024, original scientific article Abstract: The cholinergic system has been implicated in postural deficits, in particular falls, in Parkinson’s disease.
Falls and freezing of gait typically occur during dynamic and challenging balance and gait conditions,
such as when initiating gait, experiencing postural perturbations, or making turns. However, the precise
cholinergic neural substrate underlying dynamic postural and gait changes remains poorly understood.
The aim of this study was to investigate whether brain vesicular acetylcholine transporter binding, as
measured with [18F]-fluoroethoxybenzovesamicolbinding PET, correlates with dynamic gait and balance
impairments in 125 patients with Parkinson’s disease (mean age 66.89±7.71 years) using the abbreviated
Balance Evaluation Systems Test total and its four functional domain sub-scores (anticipatory postural
control, reactive postural control, dynamic gait, and sensory integration). Whole brain false discoverycorrected (P < 0.05) correlations for total abbreviated Balance Evaluation Systems Test scores included
the following bilateral or asymmetric hemispheric regions: gyrus rectus, orbitofrontal cortex, anterior part
of the dorsomedial prefrontal cortex, dorsolateral prefrontal cortex, cingulum, frontotemporal opercula,
insula, fimbria, right temporal pole, mesiotemporal, parietal and visual cortices, caudate nucleus, lateral
and medial geniculate bodies, thalamus, lingual gyrus, cerebellar hemisphere lobule VI, left cerebellar
crus I, superior cerebellar peduncles, flocculus, and nodulus. No significant correlations were found for
the putamen or anteroventral putamen. The four domain-specific sub-scores demonstrated overlapping
cholinergic topography in the metathalamus, fimbria, thalamus proper, and prefrontal cortices but also
showed distinct topographic variations. For example, reactive postural control functions involved the right
flocculus but not the upper brainstem regions. The anterior cingulum associated with reactive postural
control whereas the posterior cingulum correlated with anticipatory control. The spatial extent of
associated cholinergic system changes were least for dynamic gait and sensory orientation functional
domains compared to the anticipatory and reactive postural control functions. We conclude that specific
aspects of dynamic balance and gait deficits in Parkinson’s disease associate with overlapping but also
distinct patterns of cerebral cholinergic system changes in numerous brain regions. Our study also presents
novel evidence of cholinergic topography involved in dynamic balance and gait in Parkinson’s disease
that have not been typically associated with mobility disturbances, such as the right anterior temporal pole,
right anterior part of the dorsomedial prefrontal cortex, gyrus rectus, fimbria, lingual gyrus, flocculus,
nodulus and right cerebellar hemisphere lobules VI and left crus I. Keywords: Parkinson’s disease, dynamic balance, cholinergic, PET Published in DiRROS: 30.08.2024; Views: 169; Downloads: 457 Full text (4,32 MB) This document has many files! More... |
2. Enhancing balance in Parkinson’s disease patients : a comprehensive literature review on the efficacy of exercise in an enriched environmentAna Ponebšek, Friderika Kresal, Luka Šlosar, 2023, review article Abstract: Various physiotherapeutic methods and approaches play a significant role in the
treatment of patients with Parkinson’s disease, including the use of enriched environments. Virtual reality (VR) as a type of enriched environment has the potential to create
multiple sensory experiences and feedback, influencing various aspects of the patient’s
information processing and response. The suitability for home use and the considerable impact on motivation highlight its advantages over alternative approaches. The
objective of this review is to investigate the impact of VR-based exercise on balance
outcomes among individuals with Parkinson’s disease. The inclusion criteria consisted Parkinson’s disease. The comparable improvements in balance observed between the
experimental and control groups signify the potential effectiveness of VR-based exercises. This underscores the encouragement for further development in this technology,
particularly focusing on fully immersive VR environments, which may yield superior
effects in enhancing balance among individuals with Parkinson’s disease.
of randomized controlled trials (RCTs) that examined the effects of exercise in a VR
environment on individuals’ static and dynamic balance outcomes. In order to gather
relevant studies, we conducted a comprehensive search across three databases. From a
dataset of 625 records, we conducted a comprehensive full-text screening based on specific inclusion and exclusion criteria. This process resulted in the inclusion of 14 RCTs
in our review. The emerging evidence regarding exercising in a VR environment does
not definitively prove its superiority over standard exercise routines. However, studies
have demonstrated that both the experimental and control groups showed comparable improvements in enhancing static and dynamic balance among individuals with Keywords: virtual reality, Parkinson's disease, balance, rehabilitation Published in DiRROS: 16.04.2024; Views: 377; Downloads: 172 Full text (552,71 KB) This document has many files! More... |
3. Beta–gamma phase-amplitude coupling as a non-invasive biomarker for Parkinson’s diseas : insights from Electroencephalography studiesTisa Hodnik, Stiven Roytman, Nicolaas I. Bohnen, Uroš Marušič, 2024, review article Abstract: Phase-amplitude coupling (PAC) describes the interaction of two separate frequencies in which the lower frequency phase acts as a carrier frequency of the higher frequency amplitude. It is a means of carrying integrated streams of information between micro- and macroscale systems in the brain, allowing for coordinated activity of separate brain regions. A beta–gamma PAC increase over the sensorimotor cortex has been observed consistently in people with Parkinson’s disease (PD). Its cause is attributed to neural entrainment in the basal ganglia, caused by pathological degeneration characteristic of PD. Disruptions in this phenomenon in PD patients have been observed in the resting state as well as during movement recordings and have reliably distinguished patients from healthy participants. The changes can be detected non-invasively with the electroencephalogram (EEG). They correspond to the severity of the motor symptoms and the medication status of people with PD. Furthermore, a medication-induced decrease in PAC in PD correlates with the alleviation of motor symptoms measured by assessment scales. A beta–gamma PAC increase has, therefore, been explored as a possible means of quantifying motor pathology in PD. The application of this parameter to closed-loop deep brain stimulation could serve as a self-adaptation measure of such treatment, responding to fluctuations of motor symptom severity in PD. Furthermore, phase-dependent stimulation provides a new precise method for modulating PAC increases in the cortex. This review offers a comprehensive synthesis of the current EEG-based evidence on PAC fluctuations in PD, explores the potential practical utility of this biomarker, and provides recommendations for future research. Keywords: neurodegenerative diseases, Parkinson’s disease, electroencephalography, phase-amplitude coupling Published in DiRROS: 21.03.2024; Views: 475; Downloads: 214 Full text (604,09 KB) This document has many files! More... |
4. Neuromuscular assessment of force development, postural, and gait performance under cognitive-motor dual-tasking in healthy older adults and early Parkinson's disease patients : study protocol for a cross-sectional Mobile Brain/Body Imaging (MoBI) studyUroš Marušič, Manca Peskar, Maja Maša Šömen, Miloš Kalc, Aleš Holobar, Klaus Gramann, Bettina Wollesen, Anna Wunderlich, Christoph M. Michel, Aleksandar Miladinović, Mauro Catalan, Alex B. Stella, Miloš Ajčević, Paolo Manganotti, 2023, original scientific article Abstract: Background: Neuromuscular dysfunction is common in older adults and more pronounced in neurodegenerative diseases. In Parkinson's disease (PD), a complex set of factors often prevents the effective performance of activities of daily living that require intact and simultaneous performance of the motor and cognitive tasks. Methods: The cross-sectional study includes a multifactorial mixed-measure design. Between-subject factor grouping the sample will be Parkinson’s Disease (early PD vs. healthy). The within-subject factors will be the task complexity (single- vs. dual-task) in each motor activity, i.e., overground walking, semi-tandem stance, and isometric knee extension, and a walking condition (wide vs. narrow lane) will be implemented for the overground walking activity only. To study dual-task (DT) effects, in each motor activity participants will be given a secondary cognitive task, i.e., a visual discrimination task for the overground walking, an attention task for the semi-tandem, and mental arithmetic for the isometric extension. Analyses of DT effects and underlying neuronal correlates will focus on both gait and cognitive performance where applicable. Based on an a priori sample size calculation, a total N = 42 older adults (55-75 years) will be recruited. Disease-specific changes such as laterality in motor unit behavior and cortical control of movement will be studied with high-density surface electromyography and electroencephalography during static and dynamic motor activities, together with whole-body kinematics. Discussion: This study will be one of the first to holistically address early PD neurophysiological and neuromuscular patterns in an ecologically valid environment under cognitive-motor DT conditions of different complexities. The outcomes of the study aim to identify the biomarker for early PD either at the electrophysiological, muscular or kinematic level or in the communication between these systems. Keywords: Parkinson's disease, mobile brain imaging, body brain imaging, MoBi, dual tasking, neuromuscular function, older adults Published in DiRROS: 15.09.2023; Views: 678; Downloads: 302 Full text (1,36 MB) This document has many files! More... |
5. Brain dynamics underlying preserved cycling ability in patients with Parkinson’s disease and freezing of gaitTeja Ličen, Martin Rakuša, Nicolaas I. Bohnen, Paolo Manganotti, Uroš Marušič, 2022, review article Abstract: Parkinson’s disease (PD) is generally associated with abnormally increased beta band oscillations in the cortico-basal ganglia loop during walking. PD patients with freezing of gait (FOG) exhibit a more distinct, prolonged narrow band of beta oscillations that are locked to the initiation of movement at ∼18 Hz. Upon initiation of cycling movements, this oscillation has been reported to be weaker and rather brief in duration. Due to the suppression of the overall beta band power during cycling and its continuous nature of the movement, cycling is considered to be less demanding for cortical networks compared to walking, including reduced need for sensorimotor processing, and thus unimpaired continuous cycling motion. Furthermore, cycling has been considered one of the most efficient non-pharmacological therapies with an influence on the subthalamic nucleus (STN) beta rhythms implicative of the deep brain stimulation effects. In the current review, we provide an overview of the currently available studies and discuss the underlying mechanism of preserved cycling ability in relation to the FOG in PD patients. The mechanisms are presented in detail using a graphical scheme comparing cortical oscillations during walking and cycling in PD. Keywords: gait, freezing of gait, Parkinson's disease, cycling, cortical oscillations, beta band Published in DiRROS: 21.06.2022; Views: 819; Downloads: 674 Full text (469,86 KB) This document has many files! More... |