Assessment of Cognitive and Motor Skills in Parkinson's Disease by a Robotic Object Hitting Game

Abstract

Parkinson's disease (PD) patients experience various symptoms including extrapyramidal motor disturbances and cognitive impairments, which cause difficulties in daily life. However, PD patients have rarely been studied under realistic task situations that require high-level interaction of cognitive and motor skills. The aim of this study was to investigate the contribution of cognitive and motor factors to the performance of PD patients under high cognitive and kinematic loads. Twenty-six PD patients and 14 control subjects participated in the study. The PD patients performed a task involving hitting targets and avoiding distractors in levodopa On and Off states. A robotic manipulandum device recorded the numbers of target and distractor hits and hand kinematics, including movement area and speed. Performance on standard cognitive batteries and the Movement Disorder Society – Unified Parkinson's Disease Rating Scale motor scores were examined. The results indicated that the PD patients hit significantly fewer targets and more distractors than did the controls (p < 0.05). In PD patients, the average hand speed was slower and the area of hand movement was smaller than those of the control subjects (p < 0.001). Levodopa significantly increased the average hand speed and movement area (p < 0.01), but levodopa had an insignificant effect on the number of correct targets hit and erroneous distractor hits. The scores of cognitive batteries predicted the performance with regard to both targets hit and distractor avoidance. Our results were indicative of a dynamic interaction between cognitive and kinematic skills while the PD patients performed a virtual reality game. Single-dose levodopa enhanced kinematic capacity, and the global intelligence level predicted game performance.

Integrated robotics platform with haptic control differentiates subjects with Parkinson’s disease from controls and quantifies the motor effects of levodopa

“…In both the object hit task and object hit and avoid task , mean hand speed and limb asymmetries showed high discriminatory abilities in differentiating subjects with PD from healthly controls. Our findings support similar observations of mean hand speed by Wiratman et al [43] using the KINARM object hit and avoid task . Mean hand speed and limb asymmetries had significant correlations with UPDRS bradykinesia scores when subjects were OFF medication.…”

“…This increase was inversely correlated with a reduction in UPDRS cumulative scores. The increase in distractor hits relative to controls is consistent with a recent study by Wiratman et al [43] using the KINARM that demonstrated that patients with poor performance on standard cognitive batteries had higher distractor hits. In the present study no correlations were observed with MoCA scores but this may be due to limitations in using the MoCA to quantify cognitive function in subjects with PD.…”

Assessing various sensorimotor and cognitive functions in people with epilepsy is feasible with robotics

“…The Kinarm robotic assessment system (Kinarm, Kingston, ON, Canada) is a tool that quantifies performance on a collection of behavioral tasks that test motor, cognitive, and sensory functions, referred to as Kinarm Standard Tests™ (KSTs). It has been used to characterize deficits in a variety of clinical populations such as stroke ( [14][15][16]), ALS [17], Parkinson's disease [18], TIA [19], and concussion [20]. Furthermore, previous work has highlighted the test-retest reliability of Kinarm assessment results [21].…”

Hand Fine Motor Skill Disability Correlates with Cognition in Patients with Moderate-to-Advanced Parkinson’s Disease

“…Numerous studies have reported an association between hand fine motor skill disability and cognitive dysfunction severity [ 10 , 11 , 12 ]. Unlike AD, where memory impairment is the core symptom of dementia, the cognitive dysfunction profile in PD is heterogeneous, influencing various domains of executive function, spatial cognition, psychomotor speed, and memory [ 13 , 14 ].…”