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1.
Artigo em Inglês | MEDLINE | ID: mdl-35975211

RESUMO

A 55-year-old male presented with apraxia of gait with exaggerated upper limb movement with relative preservation of cognition and mild spasticity of limbs. His investigations reveal posterior-predominant leukodystrophy in brain magnetic resonance imaging (MRI) and compound heterozygous mutations in mitochondrial alanyl-transfer RNA synthetase 2 (AARS2) by next generation sequencing. His asymptomatic brother also has MRI changes with subtle mild pyramidal signs. AARS2 mutation is a rare cause of mitochondrial encephalopathy which may give rise to leukodystrophy with premature ovarian failure, infantile cardiomyopathy, lung hypoplasia and myopathy. Gait apraxia as primary presenting feature of this rare variant of mitochondrial encephalomyopathy is hitherto un-reported.


Assuntos
Alanina-tRNA Ligase , Leucoencefalopatias , Encefalomiopatias Mitocondriais , Alanina-tRNA Ligase/genética , Apraxia da Marcha , Humanos , Leucoencefalopatias/complicações , Leucoencefalopatias/diagnóstico por imagem , Leucoencefalopatias/genética , Masculino , Pessoa de Meia-Idade , Extremidade Superior
2.
Fluids Barriers CNS ; 19(1): 51, 2022 Jun 23.
Artigo em Inglês | MEDLINE | ID: mdl-35739555

RESUMO

BACKGROUND: Idiopathic normal pressure hydrocephalus (iNPH) is a neurological condition with gait apraxia signs from its early manifestation. Ventriculoperitoneal shunt (VPS) is a surgical procedure available for treatment. The Cerebrospinal fluid Tap Test (CSF-TT) is a quick test used as selection criterion for VPS treatment. Its predictive capacity for VPS outcomes is still sub judice. This study is aimed to test the hypothesis that wearable motion sensors provide valid measures to manage iNPH patients with gait apraxia. METHODS: Forty-two participants of the Bologna PRO-Hydro observational cohort study were included in the analyses. The participants performed the Timed Up and Go (TUG) and the 18 m walking test (18mW) with inertial sensors at baseline, three days after the CSF-TT, and six months after VPS. 21 instrumental variables described gait and postural transitions from TUG and 18mW recordings. Furthermore, participants were clinically assessed with scales (clinical variables). We tested the hypothesis by analysing the concurrent validity of instrumental and clinical variables, their individual- and group-level responsiveness to VPS, and their predictive validity for VPS outcomes after CSF-TT. RESULTS: The instrumental variables showed moderate to high correlation with the clinical variables. After VPS, most clinical and instrumental variables showed statistically significant improvements that reflect a reduction of apraxic features of gait. Most instrumental variables, but only one clinical variable (i.e., Tinetti POMA), had predictive value for VPS outcomes (significant adjusted R2 in the range 0.12-0.70). CONCLUSIONS: These results confirm that wearable inertial sensors may represent a valid tool to complement clinical evaluation for iNPH assessment and prognosis.


Assuntos
Transtornos Neurológicos da Marcha , Hidrocefalia de Pressão Normal , Marcha , Apraxia da Marcha/cirurgia , Transtornos Neurológicos da Marcha/diagnóstico , Transtornos Neurológicos da Marcha/etiologia , Humanos , Hidrocefalia de Pressão Normal/líquido cefalorraquidiano , Derivação Ventriculoperitoneal
3.
Neurocase ; 28(2): 231-234, 2022 04.
Artigo em Inglês | MEDLINE | ID: mdl-35491765

RESUMO

Clinical findings in cases of injury circumscribed with SMA is no consensus. We report the case of a 60-year-old male with circumscribed SMA injury who showed freezing of gait, and shuffling gait. Twenty-one days after onset, the patient showed difficulties with the left leg swing in gait initiation (freezing of gait). In steady-state gait, the stride of the left leg swing was short (shuffling gait). Thirty-four days after onset, this phenomenon was not observed during gait. Circumscribed SMA injury can cause gait apraxia, including freezing and shuffling gait, such as in extensive SMA injury in the medial frontal cortex.


Assuntos
Transtornos Neurológicos da Marcha , Córtex Motor , Doença de Parkinson , Marcha , Apraxia da Marcha/complicações , Transtornos Neurológicos da Marcha/etiologia , Humanos , Masculino , Pessoa de Meia-Idade , Doença de Parkinson/complicações
4.
J Neuroeng Rehabil ; 17(1): 144, 2020 10 28.
Artigo em Inglês | MEDLINE | ID: mdl-33115487

RESUMO

BACKGROUND: The past decade has seen the emergence of rehabilitation treatments using virtual reality. One of the advantages in using this technology is the potential to create positive motivation, by means of engaging environments and tasks shaped in the form of serious games. The aim of this study is to determine the efficacy of immersive Virtual Environments and weaRable hAptic devices (VERA) for rehabilitation of upper limb in children with Cerebral Palsy (CP) and Developmental Dyspraxia (DD). METHODS: A two period cross-over design was adopted for determining the differences between the proposed therapy and a conventional treatment. Eight children were randomized into two groups: one group received the VERA treatment in the first period and the manual therapy in the second period, and viceversa for the other group. Children were assessed at the beginning and the end of each period through both the Nine Hole Peg Test (9-HPT, primary outcome) and Kinesiological Measurements obtained during the performing of similar tasks in a real setting scenario (secondary outcomes). RESULTS: All subjects, not depending from which group they come from, significantly improved in both the performance of the 9-HPT and in the parameters of the kinesiological measurements (movement error and smoothness). No statistically significant differences have been found between the two groups. CONCLUSIONS: These findings suggest that immersive VE and wearable haptic devices is a viable alternative to conventional therapy for improving upper extremity function in children with neuromotor impairments. Trial registration ClinicalTrials, NCT03353623. Registered 27 November 2017-Retrospectively registered, https://clinicaltrials.gov/ct2/show/NCT03353623.


Assuntos
Paralisia Cerebral/reabilitação , Apraxia da Marcha/reabilitação , Realidade Virtual , Dispositivos Eletrônicos Vestíveis , Paralisia Cerebral/fisiopatologia , Criança , Estudos Cross-Over , Feminino , Apraxia da Marcha/fisiopatologia , Humanos , Masculino , Projetos Piloto , Método Simples-Cego , Extremidade Superior/fisiopatologia
5.
Rev Neurol ; 70(5): 161-170, 2020 Mar 01.
Artigo em Espanhol, Inglês | MEDLINE | ID: mdl-32100276

RESUMO

INTRODUCTION: Freezing of gait (FOG) is one of the most severe symptoms associated with Parkinson's disease (PD). Physiotherapy treatment could be an effective strategy for treating FOG, but no systematic review has been carried out in this regard. AIM: To identify the characteristics, methodological quality, and main outcomes of the studies that have analyzed the effects of physiotherapy interventions in FOG up to date, by performing a systematic review and a meta-analysis. PATIENTS AND METHODS: Four electronic databases were searched in order to find randomized controlled trials that provided information regarding the effects of any kind of physiotherapy treatment on FOG. The methodological quality of the included investigations was assessed by means of the PEDro scale. RESULTS: Twelve studies were identified for inclusion into the qualitative analysis, with four randomized controlled trials included in the final meta-analysis. The quality of the trials was generally good. Those physiotherapy modalities including cues were more effective for treating FOG than traditional physiotherapy approaches. The meta-analysis indicated that physiotherapy interventions had a significantly greater impact on FOG than control comparisons. CONCLUSIONS: Physiotherapy treatment, especially those modalities including visual and auditory cueing, should be prescribed to PD patients with FOG. Future studies including PD patients with cognitive impairment and FOG objective measurement tools are need to complete the existing scientific evidence.


TITLE: Fisioterapia para la congelación de la marcha en la enfermedad de Parkinson: revisión sistemática y metaanálisis.Introducción. La congelación de la marcha (CDM) es uno de los síntomas más graves asociados con la enfermedad de Parkinson (EP). El tratamiento fisioterapéutico podría ser una estrategia efectiva para su tratamiento, pero no se ha realizado ninguna revisión sistemática al respecto. Objetivo. Identificar las características, la calidad metodológica y los principales resultados de los estudios que han analizado los efectos de las intervenciones fisioterapéuticas en CDM hasta la fecha, mediante la realización de una revisión sistemática y un metaanálisis. Pacientes y métodos. Se realizaron búsquedas en cuatro bases de datos electrónicas para encontrar ensayos controlados aleatorizados que proporcionaran información con respecto a los efectos de cualquier tipo de tratamiento fisioterapéutico sobre la CDM. La calidad metodológica de las investigaciones se evaluó mediante la escala PEDro. Resultados. Se identificaron 12 estudios para su inclusión en el análisis cualitativo y cuatro ensayos controlados aleatorizados se incluyeron en el metaanálisis final. La calidad de los ensayos fue generalmente buena. Las modalidades de fisioterapia que incluían señales fueron más efectivas para tratar la CDM que los enfoques de fisioterapia tradicionales. El meta­análisis indicó que las intervenciones fisioterapéuticas tuvieron un impacto significativamente mayor sobre la CDM que las comparaciones de control. Conclusiones. El tratamiento fisioterapéutico, especialmente las modalidades que incluyen señales visuales y auditivas, debe prescribirse a los pacientes con EP con CDM. Se necesitan estudios futuros que incluyan pacientes con EP con deterioro cognitivo y herramientas de medición objetiva de la CDM para completar la evidencia científica existente.


Assuntos
Apraxia da Marcha/terapia , Doença de Parkinson/complicações , Modalidades de Fisioterapia , Confiabilidade dos Dados , Apraxia da Marcha/etiologia , Humanos , Ensaios Clínicos Controlados Aleatórios como Assunto , Resultado do Tratamento
6.
J Am Geriatr Soc ; 68(4): 803-808, 2020 04.
Artigo em Inglês | MEDLINE | ID: mdl-31880326

RESUMO

OBJECTIVES: To examine whether five major personality traits are related to the motoric cognitive risk (MCR) syndrome, a pre-dementia syndrome characterized by cognitive complaints and slow gait speed. DESIGN: Cross-sectional. SETTING: Health and Retirement Study (HRS) and the National Health and Aging Trends Survey (NHATS). PARTICIPANTS: Dementia-free older adults aged 65 to 107 years (N > 8000). MEASUREMENTS: In both samples, participants provided data on personality, cognitive complaints, and measures of gait speed, as well as on demographic factors, physical activity, depressive symptoms, and body mass index (BMI). RESULTS: Across the two samples and a meta-analysis, higher neuroticism was related to higher risk of MCR (combined odds ratio [OR] = 1.32; 95% confidence interval [CI] = 1.21-1.45; P < .001), whereas higher extraversion (combined OR = .71; 95% CI = .65-.79; P < .001) and conscientiousness (combined OR = .70; 95% CI = .62-.78; P < .001) were associated with a lower likelihood of MCR. Higher openness was also related to a lower risk of MCR in the HRS and the meta-analysis (combined OR = .77; 95% CI = .70-.85; P < .001), whereas agreeableness was protective only in the HRS (OR = .83; 95% CI = .74-.92; P < .001). Additional analyses indicated that physical activity, depressive symptoms, and BMI partially accounted for these associations. CONCLUSION: This study adds to existing research on the factors related to the risk of MCR by showing an association with personality traits. Personality assessment may help to identify individuals who may be targeted by interventions focused on reducing the risk of MCR and ultimately of dementia. J Am Geriatr Soc 68:803-808, 2020.


Assuntos
Disfunção Cognitiva/diagnóstico , Apraxia da Marcha/diagnóstico , Personalidade , Idoso , Idoso de 80 Anos ou mais , Disfunção Cognitiva/etiologia , Estudos Transversais , Feminino , Apraxia da Marcha/etiologia , Inquéritos Epidemiológicos , Humanos , Estudos Longitudinais , Masculino , Testes de Personalidade , Fatores de Risco , Síndrome
8.
Alzheimers Dement ; 15(9): 1218-1228, 2019 09.
Artigo em Inglês | MEDLINE | ID: mdl-31399334

RESUMO

INTRODUCTION: The corticobasal syndrome (CBS) is associated with several neuropathologic disorders, including corticobasal degeneration and Alzheimer's disease (AD). METHOD: In this report, we studied 43 AD patients with CBS (AD-CBS) and compared them with 42 AD patients with typical amnestic syndrome (AD-AS), as well as 15 cases of corticobasal degeneration and CBS pathology. RESULTS: Unlike AD-AS, AD-CBS had prominent motor problems, including limb apraxia (90%), myoclonus (81%), and gait disorders (70%). Alien limb phenomenon was reported in 26% and cortical sensory loss in 14%. Language problems were also more frequent in AD-CBS, and memory impairment was less frequent. AD-CBS had more tau pathology in perirolandic cortices but less in superior temporal cortex than AD-AS. In addition, AD-CBS had greater neuronal loss in the substantia nigra. DISCUSSION: AD-CBS is a clinicopathological subtype of AD with an atypical distribution of Alzheimer-type tau pathology. Greater neuronal loss in the substantia nigra may contribute to Parkinsonism which is not a feature of typical AD.


Assuntos
Doença de Alzheimer , Córtex Cerebral/patologia , Doenças Neurodegenerativas , Idoso , Doença de Alzheimer/classificação , Doença de Alzheimer/patologia , Feminino , Apraxia da Marcha/etiologia , Humanos , Masculino , Pessoa de Meia-Idade , Doenças Neurodegenerativas/diagnóstico por imagem , Doenças Neurodegenerativas/patologia , Transtornos Parkinsonianos , Lobo Temporal/patologia , Proteínas tau
9.
Mayo Clin Proc ; 94(6): 1065-1072, 2019 06.
Artigo em Inglês | MEDLINE | ID: mdl-31171116

RESUMO

Wernicke encephalopathy (WE) was first described by Carl Wernicke in 1881. WE is caused by thiamine deficiency. Alcoholism is the most common etiologic factor associated with WE in the United States, but it can occur in any patient with a nutritional deficiency state such as hyperemesis gravidarum, intestinal obstruction, and malignancy. WE is a clinical diagnosis. The common findings include mental status changes, ocular dysfunction, and a gait apraxia, present in only 10% of cases. Only a few cases of WE are diagnosed before death. Approximately 80% of patients with untreated WE have development of Korsakoff syndrome, which is characterized by memory impairment associated with confabulation. The initial clinical diagnosis of WE is critical, keeping in mind that the classic triad of symptoms is often absent. Recognition of nutritional deficiency and any portion of the classic triad should prompt treatment. Additionally, hypothermia, hypotension, and coma should raise clinical suspicion for the disease. Primary treatment includes timely administration of thiamine, for which the route and dosage remain controversial. Clinical judgment should be exercised in diagnosis and treatment (dosage, frequency, route of administration and duration) in all cases of WE. Overdiagnosis and overtreatment may be preferred to prevent prolonged or persistent neurocognitive impairments given the excellent safety profile of thiamine. Further prospective research is warranted to better understand the disease biology, risk factors, and treatment recommendations.


Assuntos
Tiamina/administração & dosagem , Encefalopatia de Wernicke/diagnóstico , Encefalopatia de Wernicke/tratamento farmacológico , Apraxia da Marcha , Humanos , Hipotensão , Transtornos da Memória , Tiamina/farmacologia , Encefalopatia de Wernicke/fisiopatologia
10.
Arq Neuropsiquiatr ; 76(10): 692-696, 2018 10.
Artigo em Inglês | MEDLINE | ID: mdl-30427509

RESUMO

OBJECTIVE: The current study translated to Portuguese and validated the normal pressure hydrocephalus (NPH) scale originally developed in English as the Grading Scale for Idiopathic Normal Pressure Hydrocephalus. METHODS: Following Guillemin's validation protocol, the last version of the Portuguese NPH scale was applied to 121 consecutive patients with a diagnosis of normal pressure hydrocephalus (73 men and 48 women) from the Group of Cerebral Hydrodynamics from July 2010 to March 2012. RESULTS: The mean age was 71.09 years old, ranging from 35 to 92 years. The rate of agreement and reproducibility was high, as confirmed by Cohen's Kappa coefficient, with excellent intraobserver correlation for the NPH scale items individually evaluated: gait (0.80), dementia (0.90) and incontinence (0.87). CONCLUSIONS: The Portuguese version of the Grading Scale for Idiopathic Normal Pressure Hydrocephalus was successfully translated and validated for use in Brazilian patients.


Assuntos
Hidrocefalia de Pressão Normal/diagnóstico , Inquéritos e Questionários/normas , Adulto , Idoso , Idoso de 80 Anos ou mais , Brasil , Comparação Transcultural , Estudos Transversais , Demência/diagnóstico , Feminino , Apraxia da Marcha/diagnóstico , Humanos , Idioma , Masculino , Pessoa de Meia-Idade , Reprodutibilidade dos Testes , Traduções , Incontinência Urinária/diagnóstico
11.
Arq Neuropsiquiatr ; 76(5): 324-331, 2018 May.
Artigo em Inglês | MEDLINE | ID: mdl-29898079

RESUMO

INTRODUCTION: Normal pressure hydrocephalus (NPH), described by Hakim and Adams in 1965, is characterized by gait apraxia, urinary incontinence, and dementia. It is associated with normal cerebrospinal fluid (CSF) pressure and ventricular dilation that cannot be attributed to cerebral atrophy. OBJECTIVES: To evaluate gait characteristics in patients with idiopathic NPH and investigate the effect of the CSF tap test (CSF-TT) on gait. METHODS: Twenty-five patients diagnosed with probable idiopathic NPH were submitted to the CSF-TT. The procedure aimed to achieve changes in gait parameters. RESULTS: Fifteen gait parameters were assessed before and after the CSF-TT. Five showed a statistically significant improvement (p < 0.05): walking speed (p < 0.001), cadence (p < 0.001), step length (p < 0.001), en bloc turning (p = 0.001), and step height (p = 0.004). CONCLUSION: This study demonstrated that gait speed was the most responsive parameter to the CSF-TT, followed by cadence, step length, en bloc turning, and step height.


Assuntos
Apraxia da Marcha/diagnóstico , Hidrocefalia de Pressão Normal/complicações , Idoso , Idoso de 80 Anos ou mais , Pressão do Líquido Cefalorraquidiano , Feminino , Apraxia da Marcha/líquido cefalorraquidiano , Apraxia da Marcha/etiologia , Apraxia da Marcha/fisiopatologia , Avaliação Geriátrica , Humanos , Hidrocefalia de Pressão Normal/líquido cefalorraquidiano , Hidrocefalia de Pressão Normal/fisiopatologia , Masculino , Estudos Prospectivos
12.
Parkinsonism Relat Disord ; 50: 19-22, 2018 05.
Artigo em Inglês | MEDLINE | ID: mdl-29477458

RESUMO

"Apraxia of gait" is not a useful concept and freezing of gait should also not be considered an apraxia. The concept of apraxia may, however, be applied to distortions of postural transitions that can accompany fronto-parietal lesions.


Assuntos
Apraxias/fisiopatologia , Apraxia da Marcha/fisiopatologia , Transtornos Neurológicos da Marcha/fisiopatologia , Equilíbrio Postural/fisiologia , Terminologia como Assunto , Humanos
13.
Medicine (Baltimore) ; 96(45): e8592, 2017 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-29137084

RESUMO

RATIONALE: Extremely sharp angular spinal deformity of healed tuberculosis can be corrected by vertebral column resection (VCR). However, the VCR techniques have many limitations including spinal column instability, greater blood loss, and greater risk of neurologic deficit. PATIENT CONCERNS: We described a new spinal osteotomy technique to collect sharp angular spinal deformity in Pott disease. A 52-year-old woman presented with back pain and gait imbalance. DIAGNOSIS: The kyphosis of healed tuberculosis was diagnosed based on history and imaging examinations. INTERVENTION: A new posterior VCR was designed to treat this disease. OUTCOMES: The neurological function improved from Japanese Orthopedic Association scale 3 to 7. The back pain and neurological function were significantly improved. The Oswestry Disability Index decreased from 92 to 34. There was also a significant decrease in back pain visual analog scale from 9 to 2. LESSONS: For cases with extremely severe Pott kyphotic deformity, the technology of modified VCR offers excellent clinical and radiographic results.


Assuntos
Cifose/cirurgia , Laminectomia/métodos , Osteotomia/métodos , Coluna Vertebral/cirurgia , Tuberculose da Coluna Vertebral/complicações , Dor nas Costas/microbiologia , Dor nas Costas/cirurgia , Feminino , Apraxia da Marcha/microbiologia , Apraxia da Marcha/cirurgia , Humanos , Cifose/microbiologia , Pessoa de Meia-Idade , Coluna Vertebral/microbiologia , Resultado do Tratamento
14.
J AAPOS ; 21(2): 167-170, 2017 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-28213087

RESUMO

We report a case of an 11-year-old boy referred for evaluation of esotropia associated with a 4-year history of intermittent headaches and vomiting triggered by sudden movements, such as sneezing and coughing. Magnetic resonance imaging (MRI) performed 3 years previously was reported to be normal. A thorough clinical examination revealed the clinical features of Dorsal midbrain syndrome with Bruns syndrome and bilateral superior oblique palsy. Advanced MRI sequences revealed a freely mobile intraventricular cysticercus causing obstructive panhydrocephalus.


Assuntos
Encefalopatias/complicações , Apraxia da Marcha/complicações , Mesencéfalo/diagnóstico por imagem , Transtornos da Motilidade Ocular/complicações , Doenças do Nervo Troclear/complicações , Encefalopatias/diagnóstico , Criança , Diagnóstico Diferencial , Apraxia da Marcha/diagnóstico , Humanos , Imageamento por Ressonância Magnética , Masculino , Transtornos da Motilidade Ocular/diagnóstico , Transtornos da Motilidade Ocular/fisiopatologia , Síndrome , Doenças do Nervo Troclear/diagnóstico , Doenças do Nervo Troclear/fisiopatologia
15.
Z Gerontol Geriatr ; 49(6): 477-82, 2016 Aug.
Artigo em Alemão | MEDLINE | ID: mdl-27464739

RESUMO

Disturbances of water and electrolyte balance are commonly encountered in older patients due to a multitude of physiological changes and preexisting morbidities with hyponatremia being the most common disorder. Even mild chronic hyponatremia can lead to cognitive deficits and gait instability and is associated with an increased rate of falls and fractures. Additionally, experimental and epidemiological data suggest that hyponatremia promotes bone resorption and therefore increases the risk of osteoporosis. Furthermore, osteoporosis and sarcopenia can be stimulated by hypomagnesemia. Hypernatremia often only results in unspecific symptoms but the condition is associated with a clearly increased mortality. As electrolyte disturbances have a high prevalence in the geriatric population and can contribute to geriatric syndromes and frailty, relevant electrolyte alterations should be excluded in all geriatric patients, in particular after a change in medication schedules.


Assuntos
Transtornos Cognitivos/mortalidade , Apraxia da Marcha/mortalidade , Hiponatremia/mortalidade , Osteoporose/mortalidade , Insuficiência Renal Crônica/mortalidade , Sarcopenia/mortalidade , Distribuição por Idade , Idoso , Idoso de 80 Anos ou mais , Causalidade , Transtornos Cognitivos/diagnóstico , Transtornos Cognitivos/terapia , Comorbidade , Medicina Baseada em Evidências , Feminino , Apraxia da Marcha/diagnóstico , Apraxia da Marcha/terapia , Alemanha , Humanos , Hiponatremia/diagnóstico , Hiponatremia/terapia , Masculino , Osteoporose/diagnóstico , Osteoporose/terapia , Prevalência , Insuficiência Renal Crônica/diagnóstico , Insuficiência Renal Crônica/terapia , Fatores de Risco , Sarcopenia/diagnóstico , Sarcopenia/terapia , Taxa de Sobrevida , Desequilíbrio Hidroeletrolítico/diagnóstico , Desequilíbrio Hidroeletrolítico/mortalidade
16.
Arq Neuropsiquiatr ; 74(6): 450-5, 2016 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-27332069

RESUMO

OBJECTIVES: To assess correlations among gait apraxia, balance impairment and cognitive performance in mild (AD1, n = 30) and moderate (AD2, n = 30) AD. METHOD: The following evaluations were undertaken: gait apraxia (Assessment Walking Skills); balance performance (Berg Balance Scale); Clinical Dementia Rating and Mini-mental State Examination (MMSE). RESULTS: While disregarding AD subgroups, Berg Balance Scale and the MMSE correlated significantly with Assessment Walking Skills and 23% of all subjects scored below its cut-off. After stratification, Berg Balance Scale correlated significantly with Assessment Walking Skills in both AD subgroups, and with the MMSE only in AD1. CONCLUSIONS: Balance impairment does not necessarily coexist with gait apraxia. Gait apraxia is more prevalent in moderate AD when compared with mild AD.


Assuntos
Doença de Alzheimer/complicações , Disfunção Cognitiva/etiologia , Apraxia da Marcha/etiologia , Equilíbrio Postural/fisiologia , Idoso , Doença de Alzheimer/fisiopatologia , Disfunção Cognitiva/fisiopatologia , Feminino , Apraxia da Marcha/diagnóstico , Apraxia da Marcha/fisiopatologia , Avaliação Geriátrica , Humanos , Masculino , Testes Neuropsicológicos , Índice de Gravidade de Doença
17.
J Neurol ; 263(6): 1156-65, 2016 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-27113598

RESUMO

New mobile technologies like smartglasses can deliver external cues that may improve gait in people with Parkinson's disease in their natural environment. However, the potential of these devices must first be assessed in controlled experiments. Therefore, we evaluated rhythmic visual and auditory cueing in a laboratory setting with a custom-made application for the Google Glass. Twelve participants (mean age = 66.8; mean disease duration = 13.6 years) were tested at end of dose. We compared several key gait parameters (walking speed, cadence, stride length, and stride length variability) and freezing of gait for three types of external cues (metronome, flashing light, and optic flow) and a control condition (no-cue). For all cueing conditions, the subjects completed several walking tasks of varying complexity. Seven inertial sensors attached to the feet, legs and pelvis captured motion data for gait analysis. Two experienced raters scored the presence and severity of freezing of gait using video recordings. User experience was evaluated through a semi-open interview. During cueing, a more stable gait pattern emerged, particularly on complicated walking courses; however, freezing of gait did not significantly decrease. The metronome was more effective than rhythmic visual cues and most preferred by the participants. Participants were overall positive about the usability of the Google Glass and willing to use it at home. Thus, smartglasses like the Google Glass could be used to provide personalized mobile cueing to support gait; however, in its current form, auditory cues seemed more effective than rhythmic visual cues.


Assuntos
Óculos , Apraxia da Marcha/reabilitação , Marcha , Aplicativos Móveis , Doença de Parkinson/reabilitação , Tecnologia Assistiva , Estimulação Acústica/métodos , Idoso , Fenômenos Biomecânicos , Sinais (Psicologia) , Estudos de Viabilidade , Feminino , Apraxia da Marcha/etiologia , Apraxia da Marcha/fisiopatologia , Humanos , Entrevistas como Assunto , Masculino , Pessoa de Meia-Idade , Doença de Parkinson/complicações , Doença de Parkinson/fisiopatologia , Periodicidade , Estimulação Luminosa/métodos , Resultado do Tratamento
18.
Brain Cogn ; 104: 48-57, 2016 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-26930369

RESUMO

Down syndrome (DS) is the most common genetic cause of intellectual disability in children. With aging, DS is associated with an increased risk for Alzheimer's disease (AD). The development of AD neuropathology in individuals with DS can result in further disturbances in cognition and behavior and may significantly exacerbate caregiver burden. Early detection may allow for appropriate preparation by caregivers. Recent literature suggests that declines in gait may serve as an early marker of AD-related cognitive disorders; however, this relationship has not been examined in individuals with DS. The theory regarding gait dyspraxia and cognitive decline in the general population is reviewed, and potential applications to the population with individuals with DS are highlighted. Challenges and benefits in the line of inquiry are discussed. In particular, it appears that gait declines in aging individuals with DS may be associated with known declines in frontoparietal gray matter, development of AD-related pathology, and white matter losses in tracts critical to motor control. These changes are also potentially related to the cognitive and functional changes often observed during the same chronological period as gait declines in adults with DS. Gait declines may be an early marker of cognitive change, related to the development of underlying AD-related pathology, in individuals with DS. Future investigations in this area may provide insight into the clinical changes associated with development of AD pathology in both the population with DS and the general population, enhancing efforts for optimal patient and caregiver support and propelling investigations regarding safety/quality of life interventions and disease-modifying interventions.


Assuntos
Envelhecimento , Doença de Alzheimer/fisiopatologia , Transtornos Cognitivos/fisiopatologia , Síndrome de Down/fisiopatologia , Apraxia da Marcha/fisiopatologia , Doença de Alzheimer/patologia , Doença de Alzheimer/psicologia , Cognição , Transtornos Cognitivos/patologia , Transtornos Cognitivos/psicologia , Síndrome de Down/patologia , Síndrome de Down/psicologia , Apraxia da Marcha/patologia , Humanos , Doenças do Sistema Nervoso , Qualidade de Vida , Risco , Substância Branca/patologia
20.
Eur Neurol ; 74(5-6): 243-50, 2015.
Artigo em Inglês | MEDLINE | ID: mdl-26624899

RESUMO

BACKGROUND/AIMS: Fampridine is sometimes reported to improve cognition and especially the information-processing speed. Motor improvement might be a confounding factor. The aim of this study was to evaluate the effects of fampridine on verbal fluencies in patients with multiple sclerosis (MS). METHODS: Fifty MS patients were included in a prospective monocentric open label trial with a mean Expanded Disability Status Scale of 5.3 ± 1.1. Assessments of verbal phonological and semantic fluencies were repeated twice (within 1 week) before fampridine treatment and twice after fampridine treatment in order to have the maximal practice effect. Gait velocity and fatigue (visual analogical scale) were also assessed. Distribution into gait responders, gait non-responders, fluency responders and fluency non-responders, was described. RESULTS: Verbal fluencies were significantly higher after fampridine treatment. No correlation was observed between phonological fluency improvement and semantic fluency improvement. Gait responders and gait non-responders did not present significant differences in verbal fluency performance and fatigue score. No correlation between gait velocity improvement and fatigue improvement compared with verbal fluency improvement was observed. CONCLUSION: Our results suggest that fampridine could have a selective procognitive effect on phonological fluency in MS, even in the gait non-responder patients.


Assuntos
4-Aminopiridina/uso terapêutico , Transtornos Cognitivos/tratamento farmacológico , Apraxia da Marcha/tratamento farmacológico , Esclerose Múltipla/tratamento farmacológico , Distúrbios da Fala/tratamento farmacológico , Medida da Produção da Fala , Comportamento Verbal/efeitos dos fármacos , Adulto , Avaliação da Deficiência , Feminino , França , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos
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