Influence of age, gender, education and dexterity on upper limb motor performance in Parkinsonian patients and healthy controls

Objective:To identify the significance of baseline motor features to the lifelong prognostic motor subtypes in a Parkinson disease (PD) cohort.Methods:In a previous study of 166 PD cases, we observed different prognosis in tremor-dominant, akinetic-rigid, and mixed subtypes. This study includes the same cases, but we excluded 10 cases with symptoms of ≥15 years duration at baseline. Relative severity of tremor, bradykinesia/akinesia, and rigidity at baseline were evaluated as predictors of the motor subtypes, which are known to have different prognosis.Results:The most common motor subtype was mixed, followed by akinetic-rigid and then the tremor-dominant. Seventy cases were not receiving antiparkinsonian drugs at baseline. The prognostic subtypes could be predicted at baseline in 85% of all and in 91% of the treatment-naive cases. Sensitivity, specificity, and positive predictive values were strong for the mixed and the akinetic-rigid but weak for the tremor-dominant subtype.Conclusions:Our data show that motor profile at baseline can predict prognosis in most PD cases. These findings can be incorporated into clinical practice.

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“…4,8,9 Although not ideal, upper limb motor assessment has also been used for PD severity by others. 33–35 …”

Section: Discussionmentioning

confidence: 99%

Baseline motor findings and Parkinson disease prognostic subtypes

Rajput

Ferguson

et al. 2017

Neurology

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“…Accelerated tapping has been shown even in a healthy elderly sample 50. An unwanted bias of tapping results by age, gender, education, and dexterity in healthy controls and PD patients is well known 45, 46, 51, 52…”

Section: Discussionmentioning

confidence: 99%

Analysis of the course of Parkinson's disease under dopaminergic therapy: Performance of “fast tapping” is not a suitable parameter

et al. 2005

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In addition to clinical rating scales, instrumental methods are employed frequently for assessment of performance or motor deficits in Parkinson's disease (PD). Many studies have analyzed such parameters in cross-sectional studies. We employed a battery of tests to investigate fine motor performance over a period of 4 years in 411 de novo parkinsonian patients from the Prado study. Specifically, tapping and pegboard testing ("plugging") were evaluated and performance on these tests compared with clinical ratings. Plugging scores correlated well with tapping scores and clinical rating at each assessment timepoint. Both tests also showed significant differences to healthy controls. Nevertheless "fast tapping" was found to be less impaired than was plugging in de novo patients. Over time, it was observed that plugging scores, but not tapping scores, exhibited changes that paralleled movements in clinical score. Plugging scores exhibited a marked response to dopaminergic therapy whereas fast tapping showed no therapeutic response. Fast tapping is certainly not suitable for assessment of bradykinesia or hypokinesia, and does not respond to dopaminergic therapy.

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“…We focused on men because men show consistently higher FTS performance, and we hypothesized that the highest possible tapping speed that requires the highest action potential frequencies would be most sensitive to differences in myelin integrity (Homann et al, 2003; Kauranen and Vanharanta, 1996; Reed et al, 2004). …”

Section: Introductionmentioning

confidence: 99%

Lifespan trajectory of myelin integrity and maximum motor speed

Bartzokis

Tingus

et al. 2010

Neurobiology of Aging

242

203

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Objective-Myelination of the human brain results in roughly quadratic trajectories of myelin content and integrity, reaching a maximum in mid-life and then declining in older age. This trajectory is most evident in vulnerable later myelinating association regions such as frontal lobes and may be the biological substrate for similar trajectories of cognitive processing speed. Speed of movement, such as maximal finger tapping speed (FTS), requires high-frequency action potential (AP) bursts and is associated with myelin integrity. We tested the hypothesis that the age-related trajectory of FTS is related to brain myelin integrity.Methods-A sensitive in vivo MRI biomarker of myelin integrity (calculated transverse relaxation rates (R 2 )) of frontal lobe white matter (FLwm) was measured in a sample of very healthy males (N = 72) between 23 and 80 years of age. To assess specificity, R 2 of a contrasting early-myelinating region (splenium of the corpus callosum) was also measured.Results-FLwm R 2 and FTS measures were significantly correlated (r = .45, p < .0001) with no association noted in the early-myelinating region (splenium). Both FLwm R 2 and FTS had Conflict of interestThe authors have no actual or potential conflicts of interest.Disclosure statement All human subjects received written and oral information about the study and signed written informed consents approved by the local institutional review board prior to study participation. NIH Public Access NIH-PA Author ManuscriptNIH-PA Author Manuscript NIH-PA Author Manuscript significantly quadratic lifespan trajectories that were virtually indistinguishable and both reached a peak at 39 years of age and declined with an accelerating trajectory thereafter. Conclusions-The results suggest that in this very healthy male sample, maximum motor speed requiring high-frequency AP burst may depend on brain myelin integrity. To the extent that the FLwm changes assessed by R 2 contribute to an age-related reduction in AP burst frequency, it is possible that other brain functions dependent on AP bursts may also be affected. Non-invasive measures of myelin integrity together with testing of basic measures of processing speed may aid in developing and targeting anti-aging treatments to mitigate age-related functional declines.

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Influence of age, gender, education and dexterity on upper limb motor performance in Parkinsonian patients and healthy controls

Cited by 16 publications

References 25 publications

Baseline motor findings and Parkinson disease prognostic subtypes

Baseline motor findings and Parkinson disease prognostic subtypes

Analysis of the course of Parkinson's disease under dopaminergic therapy: Performance of “fast tapping” is not a suitable parameter

Lifespan trajectory of myelin integrity and maximum motor speed

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