Remnants of Cardinal Symptoms of Parkinson's Disease, Not Dyskinesia, Are Problematic for Dyskinetic Patients Performing Activities of Daily Living
Introduction: The impact of levodopa-induced dyskinesia (LID) on the daily lives of patients with Parkinson's disease (PD) remains to be determined. Furthermore, evidence suggests that cardinal motor symptoms of PD may coexist with LID, but their impact on activities of daily living (ADL) relat...
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| Format: | Article |
| Language: | English |
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Frontiers Media S.A.
2019-03-01
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| Series: | Frontiers in Neurology |
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| Online Access: | https://www.frontiersin.org/article/10.3389/fneur.2019.00256/full |
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| author | Etienne Goubault Etienne Goubault Hung P. Nguyen Hung P. Nguyen Sarah Bogard Sarah Bogard Pierre J. Blanchet Pierre J. Blanchet Erwan Bézard Erwan Bézard Claude Vincent Justyna Sarna Oury Monchi Christian Duval Christian Duval |
| author_facet | Etienne Goubault Etienne Goubault Hung P. Nguyen Hung P. Nguyen Sarah Bogard Sarah Bogard Pierre J. Blanchet Pierre J. Blanchet Erwan Bézard Erwan Bézard Claude Vincent Justyna Sarna Oury Monchi Christian Duval Christian Duval |
| author_sort | Etienne Goubault |
| collection | DOAJ |
| description | Introduction: The impact of levodopa-induced dyskinesia (LID) on the daily lives of patients with Parkinson's disease (PD) remains to be determined. Furthermore, evidence suggests that cardinal motor symptoms of PD may coexist with LID, but their impact on activities of daily living (ADL) relative to LID is not known. This cross-sectional study aimed at determining the effect of LID and cardinal motor symptoms of PD on ADL in patients who were experiencing peak-dose choreic-type LID.Method: One hundred and twenty-one patients diagnosed with PD known to experience choreic-type LID were recruited for the study. Patients were asked to perform a set of ADL. Levels of LID, tremor, bradykinesia, and freezing of gait (FoG) were measured using 17 inertial sensors design to capture full body movements, while rigidity, and postural instability were assessed using clinical evaluations. Cognition was also assessed using the mini-mental state examination. Success criteria were set for each ADL using the time needed to perform the task and errors measured in 69 age-gender-matched healthy controls. Binary logistic regressions were used to identify symptoms influencing success or failure for each activity. Receiver operating characteristic curves were computed on each significant symptom, and Youden indexes were calculated to determine the critical level of symptomatology at which the performance significantly changed.Results: Results show that 97.7% of patients who presented with LID during the experiment also presented with at least one cardinal motor symptom. On average, patients took more time and did more errors during ADL. Multivariate analyses revealed that for the great majority of ADL, LID were not associated with worsening of performance; however, postural instability, tremor, rigidity, and cognitive decline significantly decreased the odds of success.Conclusions: Residual symptoms of PD, such as tremor, rigidity, and postural instability still present at peak-dose were more problematic than LID in the performance of ADL for patients experiencing slight-to-moderate LID. We also found that cognitive decline was associated with decreased performance in certain tasks. Therefore, a strategy using lower doses of medication to manage LID may be counterproductive since it would not address most of these symptoms already present in patients. |
| first_indexed | 2024-12-14T09:25:32Z |
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| language | English |
| last_indexed | 2024-12-14T09:25:32Z |
| publishDate | 2019-03-01 |
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| series | Frontiers in Neurology |
| spelling | doaj.art-8553786c134f4d52a60286ab5625c3a92022-12-21T23:08:12ZengFrontiers Media S.A.Frontiers in Neurology1664-22952019-03-011010.3389/fneur.2019.00256444842Remnants of Cardinal Symptoms of Parkinson's Disease, Not Dyskinesia, Are Problematic for Dyskinetic Patients Performing Activities of Daily LivingEtienne Goubault0Etienne Goubault1Hung P. Nguyen2Hung P. Nguyen3Sarah Bogard4Sarah Bogard5Pierre J. Blanchet6Pierre J. Blanchet7Erwan Bézard8Erwan Bézard9Claude Vincent10Justyna Sarna11Oury Monchi12Christian Duval13Christian Duval14Département des Sciences de l'Activité Physique, Université du Québec à Montréal, Montréal, QC, CanadaCentre de Recherche de l'Institut Universitaire de Gériatrie de Montréal, Montréal, QC, CanadaDépartement des Sciences de l'Activité Physique, Université du Québec à Montréal, Montréal, QC, CanadaCentre de Recherche de l'Institut Universitaire de Gériatrie de Montréal, Montréal, QC, CanadaDépartement des Sciences de l'Activité Physique, Université du Québec à Montréal, Montréal, QC, CanadaCentre de Recherche de l'Institut Universitaire de Gériatrie de Montréal, Montréal, QC, CanadaDépartement de Stomatologie, Faculté de Médecine Dentaire, Université de Montréal, Montréal, QC, CanadaDépartement de Médecine, CHU Montréal, Montréal, QC, CanadaLaboratoire de Neurophysiologie, Université de Bordeaux, Institut des Maladies Neurodégénératives, Bordeaux, FranceUnité Mixte de Recherche 5293, Centre National de la Recherche Scientifique, Institut des Maladies Neurodégénératives, Bordeaux, FranceDépartement de Réadaptation, Faculté de Médecine, Université Laval, Quebec, QC, CanadaDepartment of Clinical Neurosciences, Hotchkiss Brain Institute, University of Calgary, Calgary, AB, CanadaDepartment of Clinical Neurosciences, Hotchkiss Brain Institute, University of Calgary, Calgary, AB, CanadaDépartement des Sciences de l'Activité Physique, Université du Québec à Montréal, Montréal, QC, CanadaCentre de Recherche de l'Institut Universitaire de Gériatrie de Montréal, Montréal, QC, CanadaIntroduction: The impact of levodopa-induced dyskinesia (LID) on the daily lives of patients with Parkinson's disease (PD) remains to be determined. Furthermore, evidence suggests that cardinal motor symptoms of PD may coexist with LID, but their impact on activities of daily living (ADL) relative to LID is not known. This cross-sectional study aimed at determining the effect of LID and cardinal motor symptoms of PD on ADL in patients who were experiencing peak-dose choreic-type LID.Method: One hundred and twenty-one patients diagnosed with PD known to experience choreic-type LID were recruited for the study. Patients were asked to perform a set of ADL. Levels of LID, tremor, bradykinesia, and freezing of gait (FoG) were measured using 17 inertial sensors design to capture full body movements, while rigidity, and postural instability were assessed using clinical evaluations. Cognition was also assessed using the mini-mental state examination. Success criteria were set for each ADL using the time needed to perform the task and errors measured in 69 age-gender-matched healthy controls. Binary logistic regressions were used to identify symptoms influencing success or failure for each activity. Receiver operating characteristic curves were computed on each significant symptom, and Youden indexes were calculated to determine the critical level of symptomatology at which the performance significantly changed.Results: Results show that 97.7% of patients who presented with LID during the experiment also presented with at least one cardinal motor symptom. On average, patients took more time and did more errors during ADL. Multivariate analyses revealed that for the great majority of ADL, LID were not associated with worsening of performance; however, postural instability, tremor, rigidity, and cognitive decline significantly decreased the odds of success.Conclusions: Residual symptoms of PD, such as tremor, rigidity, and postural instability still present at peak-dose were more problematic than LID in the performance of ADL for patients experiencing slight-to-moderate LID. We also found that cognitive decline was associated with decreased performance in certain tasks. Therefore, a strategy using lower doses of medication to manage LID may be counterproductive since it would not address most of these symptoms already present in patients.https://www.frontiersin.org/article/10.3389/fneur.2019.00256/fullParkinson diseaselevodopa-induced dyskinesiaactivities of daily livingmotor performancecardinal symptoms |
| spellingShingle | Etienne Goubault Etienne Goubault Hung P. Nguyen Hung P. Nguyen Sarah Bogard Sarah Bogard Pierre J. Blanchet Pierre J. Blanchet Erwan Bézard Erwan Bézard Claude Vincent Justyna Sarna Oury Monchi Christian Duval Christian Duval Remnants of Cardinal Symptoms of Parkinson's Disease, Not Dyskinesia, Are Problematic for Dyskinetic Patients Performing Activities of Daily Living Frontiers in Neurology Parkinson disease levodopa-induced dyskinesia activities of daily living motor performance cardinal symptoms |
| title | Remnants of Cardinal Symptoms of Parkinson's Disease, Not Dyskinesia, Are Problematic for Dyskinetic Patients Performing Activities of Daily Living |
| title_full | Remnants of Cardinal Symptoms of Parkinson's Disease, Not Dyskinesia, Are Problematic for Dyskinetic Patients Performing Activities of Daily Living |
| title_fullStr | Remnants of Cardinal Symptoms of Parkinson's Disease, Not Dyskinesia, Are Problematic for Dyskinetic Patients Performing Activities of Daily Living |
| title_full_unstemmed | Remnants of Cardinal Symptoms of Parkinson's Disease, Not Dyskinesia, Are Problematic for Dyskinetic Patients Performing Activities of Daily Living |
| title_short | Remnants of Cardinal Symptoms of Parkinson's Disease, Not Dyskinesia, Are Problematic for Dyskinetic Patients Performing Activities of Daily Living |
| title_sort | remnants of cardinal symptoms of parkinson s disease not dyskinesia are problematic for dyskinetic patients performing activities of daily living |
| topic | Parkinson disease levodopa-induced dyskinesia activities of daily living motor performance cardinal symptoms |
| url | https://www.frontiersin.org/article/10.3389/fneur.2019.00256/full |
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