Redefining Bradykinesia

Bologna, Matteo; Espay, Alberto J.; Fasano, Alfonso; Paparella, Giulia; Hallett, Mark; Berardelli, Alfredo

doi:10.1002/mds.29362

Cited by 38 publications

(31 citation statements)

References 60 publications

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“…Hence, the relationship between motor and cognitive abnormalities in ET may be rooted in extracerebellar, more diffuse alterations encompassing various brain areas and circuits. Such a hypothesis aligns with both (i) the notion that bradykinesia likely arises from network dysfunction rather than the dysfunction of a singular brain area [3,12,24], and (ii) the established understanding that memory is a complex cognitive function with diffuse physiological bases in the brain. Hence, it is plausible that a more intricate involvement of brain structures beyond the cerebello-thalamo-cortical pathway contributes to cognitive function in ET [15,30,52].…”

Section: Discussionmentioning

confidence: 52%

“…Essential tremor (ET) is a heterogeneous condition de ned by the presence of bilateral action tremor of the upper limbs [1], and possibly, various motor and non-motor symptoms, i.e., 'soft signs,' con guring the ET-plus de nition [1]. In this context, individuals with ET may exhibit a mild slowing of voluntary movement, often referred to as bradykinesia [2][3][4][5][6][7][8][9][10][11][12][13], and the impaired movement performance cannot be solely attributed to the secondary effects of tremor [3][4][5][6][7][9][10][11]. Furthermore, various studies have documented the presence of cognitive dysfunction in ET patients [2,7,8,[13][14][15][16][17][18][19].…”

Section: Introductionmentioning

confidence: 99%

“…Various potential pathophysiological mechanisms have been suggested to explain motor and cognitive disturbances in ET, including dysfunction in both the cerebellum and extra-cerebellar areas. Data from animal and human studies demonstrate that some movement parameters, including velocity, are encoded in cerebellar neural activity [22,23], and that cerebellar diseases, including ET, are associated with slowed movement execution [3,12,24]. Nevertheless, additional mechanisms may be implicated.…”

Section: Introductionmentioning

confidence: 99%

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Insight Into the Relationship Between Motor and Cognitive Symptoms in Essential Tremor

Paparella,

Angelini,

Margiotta

et al. 2024

Preprint

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Introduction: Essential tremor (ET) is a heterogeneous disorder characterized by bilateral upper limbs action tremor and, possibly, neurological signs of uncertain significance, including voluntary movement abnormalities and cognitive disturbances, i.e., the so-called ‘soft’ signs configuring ET-plus definition. While motor and cognitive disturbances often coexist in ET, their interrelationship remains largely unexplored. Here we aim to further investigate the relationship between motor symptoms, objectively assessed through kinematic analysis, and cognitive dysfunctions in ET. Methods: 70 ET patients underwent clinical examination, as well as kinematic recordings of tremor and finger tapping and a thorough cognitive assessment. We then tested clinic-demographic and kinematic differences between patients with and without cognitive abnormalities, i.e., with mild cognitive impairment (MCI). Correlation analysis served to explore potential associations between kinematic and cognitive data. Results: 43 ET patients (61.42%) had MCI. ET-MCI patients exhibited reduced movement velocity during finger tapping compared to those with normal cognition (p<0.001). Lower movement velocity during finger tapping was associated with poorer cognitive performance. Namely, we observed a correlation between movement velocity and performance on the Babcock Story Immediate and Delayed Recall Test (r=0.52 and r=0.45, both p<0.001), as well as the interference memory task at 10 and 30 seconds (r=0.3, p=0.008 and r=0.2, p=0.03). Conclusions: In this study, we have provided data for a better pathophysiological interpretation of motor and cognitive signs in ET, including the role played by the cerebellum or extra-cerebellar areas, which possibly underpin both signs.

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Section: Discussionmentioning

confidence: 52%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Insight Into the Relationship Between Motor and Cognitive Symptoms in Essential Tremor

Paparella,

Angelini,

Margiotta

et al. 2024

Preprint

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“…In this regard, kinematic analysis of finger tapping, which includes the repetitive opposition movement of the thumb and index finger over time, is one of the most valuable approaches for assessing bradykinesia and evaluating the impact of dopaminergic replacement in PD [ 7 , 9 , 11 ]. Several studies have demonstrated that bradykinesia features include decreased voluntary movement velocity as well as reduced movement amplitude (hypokinesia) and a decline in both amplitude and speed during repetitive movement (sequence effect) [ 7 , 12 , 13 ]. These features may vary in their presence across PD patients, and they might exhibit different sensitivity to changes in response to dopamine replacement therapy [ 8 , 13 ].…”

Section: Introductionmentioning

confidence: 99%

Objective assessment of the effects of opicapone in Parkinson’s disease through kinematic analysis

Bologna,

Guerra,

Colella

et al. 2023

Neurol Sci

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Background Opicapone (OPC) is a third-generation, selective peripheral COMT inhibitor that improves peripheral L-DOPA bioavailability and reduces OFF time and end-of-dose motor fluctuations in Parkinson’s disease (PD) patients. Objectives In this study, we objectively assessed the effects of adding OPC to L-DOPA on bradykinesia in PD through kinematic analysis of finger movements. Methods We enrolled 20 treated patients with PD and motor fluctuations. Patients underwent two experimental sessions (L-DOPA, L-DOPA + OPC), separated by at least 1 week. In each session, patients were clinically evaluated and underwent kinematic movement analysis of repetitive finger movements at four time points: (i) before their usual morning dose of L-DOPA (T0), (ii) 30 min (T1), (iii) 1 h and 30 min (T2), and (iv) 3 h and 30 min after the L-DOPA intake (T3). Results Movement velocity and amplitude of finger movements were higher in PD patients during the session with OPC compared to the session without OPC at all the time points tested. Importantly, the variability of finger movement velocity and amplitude across T0–T3 was significantly lower in the L-DOPA + OPC than L-DOPA session. Conclusions This study is the first objective assessment of the effects of adding OPC to L-DOPA on bradykinesia in patients with PD and motor fluctuations. OPC, in addition to the standard dopaminergic therapy, leads to significant improvements in bradykinesia during clinically relevant periods associated with peripheral L-DOPA dynamics, i.e., the OFF state in the morning, delayed-ON, and wearing-OFF periods.

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“…The results of this study indicate that the measures provided by The Hand Tracking Tool might be useful to quantify bradykinesia from videos. There is significant variability in how the term bradykinesia is applied in the literature and it is frequently used interchangeably with hypokinesia and akinesia (Bologna et al, 2020(Bologna et al, , 2023. As a result, there is an ongoing debate as to the definition, clinical application and evolution of the term that have led to various inconsistencies that have been repeatedly discussed in the literature (Bologna et al, 2020(Bologna et al, , 2023Schilder et al, 2017).…”

Section: Correlation With Mds-updrs III Item 4 Scorementioning

confidence: 99%

An Artificial Intelligence Video-Based Assessment of Upper-limb Bradykinesia in Parkinson’s Disease

Guarín

Wong

Ramirez‐Zamora

2023

Preprint

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As there is a lack of an objective biomarker for Parkinson’s disease (PD), the clinical practice relies on serial neurologic assessments to track and characterize disease progression. These clinical scales lack the resolution to detect subtle changes, classify the movements into broad categories, require significant expertise for proper application, and are not sensible enough for early diagnosis; imaging markers are objective and sensible for early diagnosis but are costly and not commonly available. The video-based movement measures estimated using AI algorithms for motion tracking represent a novel alternative for diagnosing and assessing PD. Video-based measures are objective, sensitive to small changes, inexpensive, and easily accessible. This paper explores the correlation between objective kinematics measures derived from videos of the Finger Tapping Test using AI-based algorithms for markerless motion tracking with well-established clinical and imaging markers of disease progression in PD. The results demonstrate that AI-based algorithms for markerless motion tracking accurately track hand movements during the Finger Tapping Test. Different movement aspects, such as speed, duration, amplitude, and rhythm alterations, can be quantified from the videos. Our analysis showed that these video-based measures were significantly correlated with clinical rating scales, including the Movement Disorder Society – Parkinson’s Disease Rating Scale Part III and its Finger Tapping subscore. Additionally, some measures significantly correlated with imaging markers, such as Free Water in the posterior Substantia Nigra. Furthermore, video-based measures could detect the presence of PD from the Finger Tapping Test videos with high accuracy. The best classification model achieved an average accuracy of 95% and an area under the receiver operating characteristic curve of 0.87. Finally, we introduce The Hand Tracking Tool, an easy-to-use interface for analyzing Finger Tapping Test videos using AI-based algorithms for markerless motion tracking and obtaining objective movement measures.

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Redefining Bradykinesia

Cited by 38 publications

References 60 publications

Insight Into the Relationship Between Motor and Cognitive Symptoms in Essential Tremor

Insight Into the Relationship Between Motor and Cognitive Symptoms in Essential Tremor

Objective assessment of the effects of opicapone in Parkinson’s disease through kinematic analysis

An Artificial Intelligence Video-Based Assessment of Upper-limb Bradykinesia in Parkinson’s Disease

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