Is DOPA-Responsive Hypokinesia Responsible for Bimanual Coordination Deficits in Parkinson’s Disease?

Abstract

Bradykinesia is a well-documented DOPA-responsive clinical feature of Parkinson’s disease (PD). While amplitude deficits (hypokinesia) are a key component of this slowness, it is important to consider how dopamine influences both the amplitude (hypokinesia) and frequency components of bradykinesia when a bimanually coordinated movement is required. Based on the notion that the basal ganglia are associated with sensory deficits, the influence of dopaminergic replacement on sensory feedback conditions during bimanual coordination was also evaluated. Bimanual movements were examined in PD and healthy comparisons in an unconstrained three-dimensional coordination task. PD were tested “off” (overnight withdrawal of dopaminergic treatment) and “on” (peak dose of dopaminergic treatment), while the healthy group was evaluated for practice effects across two sessions. Required cycle frequency (increased within each trial from 0.75 to 2 Hz), type of visual feedback (no vision, normal vision, and augmented vision), and coordination pattern (symmetrical in-phase and non-symmetrical anti-phase) were all manipulated. Overall, coordination (mean accuracy and standard deviation of relative phase) and amplitude deficits during bimanual coordination were confirmed in PD participants. In addition, significant correlations were identified between severity of motor symptoms as well as bradykinesia to greater coordination deficits (accuracy and stability) in PD “off” group. However, even though amplitude deficits (hypokinesia) improved with dopaminergic replacement, it did not improve bimanual coordination performance (accuracy or stability) in PD patients from “off” to “on.” Interestingly, while coordination performance in both groups suffered in the augmented vision condition, the amplitude of the more affected limb of PD was notably influenced. It can be concluded that DOPA-responsive hypokinesia contributes to, but is not directly responsible for bimanual coordination impairments in PD. It is likely that bimanual coordination deficits in PD are caused by the combination of dopaminergic system dysfunction as well as other neural impairments that may be DOPA-resistant or related to non-dopaminergic pathways.

Corticospinal Modulations during Bimanual Movement with Different Relative Phases

“…The absolute delta RP during BM movement with 0° and 180° RP in healthy participants observed in our present study was similar to that in healthy elderly humans, but was smaller than that in patients with Parkinson’s disease (Almeida and Brown, 2013 ). Moreover, the absolute delta RP and SD of absolute delta RP during BM movement with 90° RP were larger than those during BM movement with the other RPs, which was consistent with previous findings (Yamanishi et al, 1980 ; Tuller and Kelso, 1989 ; Zanone and Kelso, 1992 ; Lee et al, 1995 ; James et al, 2010 ).…”

Quantifying upper limb motor impairment in people with Parkinson’s disease: a physiological profiling approach

“…The discrepancy between studies could be attributed to the O’Suilleabhain et al study using a passive positioning test as opposed to the active positioning used in the current study, which would have potentially eliminated the role of central motor commands contributing to position sense at the elbow (for review, see ( Proske & Gandevia, 2012 ; Proske & Gandevia, 2018 )). While Quincy & Brown (2013) reported no improvement in bimanual task performance during the ‘on’ medication state, comparisons with the current study are limited due to differences in the test performed and the parameters used to quantify performance. Finally, differences in performances between medication states for measures of simple reaction time are equivocal ( Gauntlett-Gibson & Brown, 1998 ; Harrison, Henderson & Kennard, 1995 ; Velasco & Velasco, 1973 ; Bloxham, Dick & Moore, 1987 ; Puliman et al, 1988 ; Starkstein et al, 1989 ; Rafal et al, 1984 ), with more complex tests (i.e., choice reaction time) appearing more sensitive in discriminating between the ‘on’ and ‘off’ states.…”

Inter-limb coupling during diadochokinesis in Parkinson's and Huntington's disease

“…Indeed, several studies have demonstrated that bimanual coordination is hampered in PD patients (Brown et al, 1993;Johnson et al, 1998;Almeida et al, 2002;Byblow et al, 2002;Alberts et al, 2004Alberts et al, , 2008Ponsen et al, 2006;Nieuwboer et al, 2009;Stegemoller et al, 2009;Wu et al, 2010;Brown and Almeida, 2011;Almeida and Brown, 2013). These deficits range from the organization and execution of simultaneous and sequential movements of the upper limbs (Schwab et al, 1954;Benecke et al, 1987;Marsden, 1989;Harrington and Haaland, 1991;Klockgether and Dichgans, 1994;Bennett et al, 1995;Weiss et al, 1997;Alberts et al, 1998;Johnson et al, 1998), to decreased degree of phasing accuracy and stability (Swinnen et al, 1997;Johnson et al, 1998;Serrien et al, 2000), and several others.…”