RESUMEN
PURPOSE: Despite the overall benefits of deep brain stimulation (DBS) in Parkinson's disease (PD), its effects on speech production have been mixed when examined using auditory-perceptual and acoustic measures. This study investigated the effects of DBS on the lip and jaw kinematics during sentence production in individuals with dysarthria secondary to PD. METHOD: Twenty-seven participants from three groups were included in the study: (a) individuals with PD and without DBS (PD group), (b) individuals with PD and with DBS (PD-DBS group), and (c) neurologically healthy control speakers (HC group). Lip and jaw movements during speech were recorded using optical motion capture and analyzed for path distance, speed, duration, articulatory stability, and interarticulator coordination. RESULTS: The PD-DBS group showed (a) increased path distance compared with the PD and HC groups and (b) increased speed compared with the PD group but not the HC group. Both PD and PD-DBS groups exhibited lengthened sentence duration compared with the HC group. Articulatory stability was greater for the two PD groups, PD and PD-DBS, compared with the HC group. Spatial, but not temporal, coordination was lower for the PD group than for the other two groups. The only kinematic changes between the DBS on and off conditions within the PD-DBS group were increases in spatial coordination. CONCLUSIONS: These data suggest that DBS primarily affects the amplitude scaling of articulatory movements, but not the temporal scaling, in individuals with PD. The findings are discussed with respect to the DBS-induced neural changes and their effects on speech motor control in PD.
Asunto(s)
Estimulación Encefálica Profunda , Enfermedad de Parkinson , Núcleo Subtalámico , Humanos , Enfermedad de Parkinson/complicaciones , Enfermedad de Parkinson/terapia , Estimulación Encefálica Profunda/métodos , Disartria/terapia , Disartria/complicaciones , Inteligibilidad del Habla/fisiologíaRESUMEN
BACKGROUND: The Movement Disorders Society (MDS) recently proposed guidelines for diagnosis of mild cognitive impairment in Parkinson's disease (PD-MCI) that includes two assessment levels: abbreviated (Level I) and comprehensive (Level II). The aim of this study was to determine the utility of the Mattis Dementia Rating Scale (MDRS), a recommended Level I test, for detecting Level II PD-MCI diagnosis. METHODS: The study sample included 30 patients diagnosed with PD-MCI based on Level II MDS criteria and 68 PD patients with normal cognition (PD-NC). Receiver operator curve (ROC) analyses were generated to measure the sensitivity and specificity of various MDRS cutoff scores. To examine the utility of the MDRS as a screening tool, the optimal cutoff point was defined as the lowest value providing ≥80% sensitivity. For use of the MDRS as a diagnostic tool, the optimal cutoff point was defined as the highest value providing ≥80% specificity. RESULTS: ROC analyses showed that the optimal MDRS cutoff score for screening purposes and diagnostic purposes were ≤140 and ≤137, respectively. However, an examination of sensitivity/specificity values for the screening cutoff scores suggested that a total score of ≤139 for screening purposes yielded a better balance between sensitivity (77%) and specificity (65%). CONCLUSIONS: In a clinical setting, in which detection of PD-MCI may be important, a total MDRS score of ≤139 can be used to detect PD-MCI. In research and other settings in which diagnostic certainty is more important, a score of ≤137 may be more useful.
Asunto(s)
Trastornos del Conocimiento/complicaciones , Trastornos del Conocimiento/diagnóstico , Pruebas Neuropsicológicas , Enfermedad de Parkinson/complicaciones , Anciano , Análisis de Varianza , Femenino , Humanos , Modelos Logísticos , Masculino , Persona de Mediana Edad , Curva ROC , Estados Unidos , United States Department of Veterans AffairsRESUMEN
OBJECTIVE: Although it is well known that Parkinson's disease (PD) with dementia results in functional decline, little is known about the impact of mild cognitive impairment in PD (PD-MCI) on day-to-day functioning. METHOD: Forty-one individuals with PD-MCI, 56 PD patients with normal cognition (PD-NC), and 47 healthy older adults were administered two performance-based measures of instrumental activities of daily living (IADLs) that evaluated medication and financial management. Informants of the PD patients were also administered an IADL questionnaire. RESULTS: There were no significant differences between PD-NC and healthy older adults on the performance-based measures of medication and financial management. However, PD-MCI patients demonstrated significantly lower scores on the performance-based measures of medication and financial management compared with healthy older adults. PD-MCI patients were also impaired compared with PD-NC patients on performance-based medication management, but no difference between these groups was observed for ability to manage finances. Performance-based financial and medication management did not correlate with scores on neuropsychological measures in PD-MCI patients. PD-MCI and PD-NC patients showed comparable scores on the informant-based IADL questionnaire. CONCLUSIONS: Performance-based measures of IADLs, particularly medication management ability, are sensitive to subtle functional declines in PD-MCI. Although impairment in performance-based measures is associated with cognitive status in PD, IADLs may be a separate domain of functioning from cognitive functioning in PD-MCI as these measures did not correlate with performance on the neuropsychological measures. Overall, performance-based assessment of IADLs may add to the clinical evaluation of PD-MCI.