Idiopathic Normal Pressure Hydrocephalus and Progressive Supranuclear Palsy: Two Single Entities or Neurodegenerative Overlap Syndrome? A Case Report.

The differential diagnosis of idiopathic normal pressure hydrocephalus (iNPH) and progressive supranuclear palsy (PSP) is difficult. The importance of proper diagnosis is particularly important for iNPH, which can be effectively treated with a ventriculoperitoneal (VP) shunt. In our case report, we present a unique case of a patient with overlapping symptoms and radiological findings of iNPH and PSP. Our patient underwent the VP shunt after a differential diagnostic evaluation which resulted in significant improvement in their clinical condition and quality of life, albeit for a short time.

Effect of Tai-chi on balance, mood, cognition, and quality of life in women with multiple sclerosis: A one-year prospective study.

INTRODUCTION: One of the most debilitating problems encountered by people with multiple sclerosis (MS) is the loss of balance and coordination. Our study aimed to comprehensively evaluate the effectiveness of one year of Tai-chi exercise in patients with MS using both subjective and objective methods, including posturography. METHODS: This was a single-group longitudinal one-year study performed from the 1st of January 2019 to the 1st of January 2020. The primary outcomes of interest were the Mini-Balance Evaluation Systems Test (Mini-BESTest) and static posturography measures as objective methods to detect subtle changes associated with postural control/balance impairment. Secondary outcomes were measures of depression, anxiety, cognitive performance, and quality of life. All objective and subjective parameters were assessed four times: at baseline, and after three, six and 12 months of regular Tai-chi training. The difference was calculated as a subtraction of baseline values from every timepoint value for each measurement. If the normality test was passed, parametric one-sample t-test was used, if failed, Wilcoxon signed ranks test was used to test the difference between the baseline and each timepoint. Alpha was set to 0.017 using Bonferroni correction for multiple comparisons. RESULTS: Out of 25 patients with MS enrolled, 15 women with MS (mean age 44.27 years) were included for statistical analyses after completing the 12-month program. After 12 months, significant improvements were found in all objective balance and gait tests: Mini-BESTest (p<0.001), static posturography measures (total area of the centre of foot pressure - TA; p = 0.015), 25 Feet Walk Test (25FWT; p = 0.001), anxiety (Beck Anxiety Inventory - BAI; p = 0.005) and cognition tests (Paced Auditory Serial Addition Test - PASAT; p = 0.003). Measures of depression (Beck Depression Inventory - BDI; p = 0.071), cognition (Symbol Digit Modalities Test - SDMT; p = 0.079), and health-related quality of life (European Quality of Life 5-Dimensions Questionnaire - EQ-5D-5L; p = 0.095) showed a trend of improvement but were not significant, which could be the result of a small sample and increased bias due the type II error. CONCLUSION: According to these preliminary results, this study indicates the possible beneficial effects of long-term Tai-chi training on patients with MS. Although these findings need to be confirmed by further studies with a larger sample of participants of both genders and require more rigorous randomized controlled trials (RCT) design, our findings support the recommendation of regular and long-term Tai-chi exercise in patients with MS. GOV IDENTIFIER (RETROSPECTIVELY REGISTERED): NCT05474209.

Processing moving visual scenes during upright stance in elderly patients with mild cognitive impairment.

BACKGROUND: The ability to maintain balance in an upright stance gradually worsens with age and is even more difficult for patients with cognitive disorders. Cognitive impairment plays a probable role in the worsening of stability. The purpose of this study was to expose subjects with mild cognitive impairment (MCI) and healthy, age-matched controls to moving visual scenes in order to examine their postural adaptation abilities. METHODS: We observed postural responses to moving visual stimulation while subjects stood on a force platform. The visual disturbance was created by interposing a moving picture in four directions (forward, backward, right, and left). The pre-stimulus (a static scene for 10 s), stimulus (a dynamic visual scene for 20 seconds) and post-stimulus (a static scene for 20 seconds) periods were evaluated. We separately analyzed the total path (TP) of the center of pressure (COP) and the root mean square (RMS) of the COP displacement in all four directions. RESULTS: We found differences in the TP of the COP during the post-stimulus period for all stimulus directions except in motion towards the subject (left p = 0.006, right p = 0.004, and away from the subject p = 0.009). Significant RMS differences between groups were also observed during the post-stimulus period in all directions except when directed towards the subject (left p = 0.002, right p = 0.007, and away from the subject p = 0.014). CONCLUSION: Exposing subjects to a moving visual scene induced greater destabilization in MCI subjects compared to healthy elderly controls. Surprisingly, the moving visual scene also induced significant aftereffects in the MCI group. Our findings indicate that the MCI group had diminished adaptation to the dynamic visual scene and recovery. These results suggest that even mild cognitive deficits can impair sensory information integration and alter the sensory re-weighing process.

Assessment of Visual Reliance in Balance Control: An Inexpensive Extension of the Static Posturography.

Ability of humans to maintain balance in an upright stance and during movement activities is one of the most natural skills affecting everyday life. This ability progressively deteriorates with increasing age, and balance impairment, often aggravated by age-related diseases, can result in falls that adversely impact the quality of life. Falls represent serious problems of health concern associated with aging. Many investigators, involved in different science disciplines such as medicine, engineering, psychology, and sport, have been attracted by a research of the human upright stance. In a clinical practice, stabilometry based on the force plate is the most widely available procedure used to evaluate the balance. In this paper, we have proposed a low-cost extension of the conventional stabilometry by the multimedia technology that allows identifying potentially disturbing effects of visual sensory information. Due to the proposed extension, a stabilometric assessment in terms of line integral of center of pressure (COP) during moving scene stimuli shows higher discrimination power between young healthy and elderly subjects with supposed stronger visual reliance.

Postural reactions to neck vibration in Parkinson's disease.

To test the hypothesis that reduced reactions to proprioceptive input signals contribute to postural instability in Parkinson's disease (PD), pulses of mechanical vibration were applied to the neck muscles of PD patients and healthy controls. This stimulus elicits postural reactions in standing subjects. Participating were 13 moderately affected PD patients, 13 severely affected PD patients, and 13 age-matched healthy subjects. Patients were tested on and off medication. Three-second-long pulses of vibration were regularly (10 times) applied to the posterior neck muscles while subjects kept their eyes open or closed. Postural responses to the stimuli were measured by static posturography. No intergroup difference in the pattern and latencies of responses was found. However, the amplitudes of the postural reactions (shift of center of foot pressure) were significantly larger in advanced PD patients; those of moderately affected PD patients did not differ from those of control subjects. Moreover, the size of postural responses in both latter groups decreased across the trial contrary to that of advanced PD patients. Comparison of the measures during on and off testing revealed no significant differences. These results indicate that neither afferent proprioceptive deficits nor central integrative functions but rather scaling and habituation of erroneous proprioceptive information are disturbed in the postural control of advanced PD. Nondopaminergic structures seem to be responsible for this impairment.

Alterations in transport path differentially affect temporal and spatial movement parameters.

Many studies have examined the coordination of reach-to-grasp movements. However, there is debate regarding the mechanism of coordination between the transport and grasp components. The current study investigated the stability of temporal and spatial measures for reaches in which transport path was altered early or late in the reaching action. Transport alteration was accomplished by placing an obstacle either 10 cm (near) or 20 cm (far) from the hand starting position. Obstacle location affected the formation of transport path such that maximum wrist elevation coincided with the location of the obstacle. Kinematic analyses revealed that reaches over the near obstacle significantly prolonged transport time and time to maximum velocity compared with reaches over the far obstacle. A similar pattern of results was observed for the grasp component; reaches over the near obstacle resulted in a prolongation of grip duration, time to maximum aperture, and time to maximum opening and closing velocity. Grip closing velocity was decreased in the obstacle conditions. These results confirm findings from earlier studies that have shown that changes in the transport component affect grasp formation. A spatial and temporal analysis of grasp opening and closing was also performed. Grasp closing time varied significantly between conditions, while closing distance or the distance traveled by the wrist after maximum aperture remained essentially constant across conditions. These results suggest that the central nervous system may be using a spatial controller to coordinate prehensile components.