Dopaminergic and non-dopaminergic gait components assessed by instrumented timed up and go test in Parkinson’s disease

Dibilio, Valeria; Mostile, Giovanni; Toscano, Simona; Luca, Antonina; Raciti, Loredana; Sciacca, Giorgia; Vasta, Rosario; Cicero, Calogero Edoardo; Contrafatto, Donatella

doi:10.1007/s00702-017-1794-8

Cited by 12 publications

(28 citation statements)

References 42 publications

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“…In a recent study, patients with MSA and PSP had similar mean (SD) TUG times (18 (6.5) s and 22.4 (15.5) s respectively) as the iNPH patients in the current study (22.2 (12.1) s) while patients with idiopathic PD and stable doses of dopaminergic ( l -dopa) therapy had faster TUG times (12 (3.4) s) [ 43 ]. The effect of l -dopa on the TUG test was also reported in another study where PD patients on and off l -dopa had TUG times of 20.2 (12.6) s and 15.4 (5.2) s, respectively [ 44 ]. This effect of l -dopa closely resembles the treatment effect of shunt surgery in iNPH with pre- and post-operative TUG times of 22.2 s and 16.9 s, respectively.…”

Section: Discussionsupporting

confidence: 53%

The timed up and go test in idiopathic normal pressure hydrocephalus: a Nationwide Study of 1300 patients

Sundström

Rydja

Virhammar

et al. 2022

Fluids Barriers CNS

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Background The aim of this study was to describe the outcome measure timed up and go (TUG) in a large, nationwide cohort of patients with idiopathic normal pressure hydrocephalus (iNPH) pre- and post-operatively. Furthermore, to compare the TUG test to the 10-m walk test (10MWT), the iNPH scale, the modified Rankin scale (mRS) and the Mini Mental State Examination (MMSE), which are commonly applied in clinical assessment of iNPH. Methods Patients with iNPH (n = 1300), registered in the Swedish Hydrocephalus Quality Registry (SHQR), were included. All data were retrieved from the SHQR except the 10MWT, which was collected from patient medical records. Clinical scales were examined pre- and 3 months post-operatively. Data were dichotomised by sex, age, and preoperative TUG time. Results Preoperative TUG values were 19.0 [14.0–26.0] s (median [IQR]) and 23 [18–30] steps. Post-operatively, significant improvements to 14.0 [11.0–20.0] s and 19 [15–25] steps were seen. TUG time and steps were higher in women compared to men (p < 0.001) but there was no sex difference in improvement rate. Worse preoperative TUG and younger age favoured improvement. TUG was highly correlated to the 10MWT, but correlations of post-operative changes were only low to moderate between all scales (r = 0.22–0.61). Conclusions This study establishes the distribution of TUG in iNPH patients and shows that the test captures important clinical features that improve after surgery independent of sex and in all age groups, confirming the clinical value of the TUG test. TUG performance is associated with performance on the 10MWT pre- and post-operatively. However, the weak correlations in post-operative change to the 10MWT and other established outcome measures indicate an additional value of TUG when assessing the effects of shunt surgery.

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Section: Discussionsupporting

confidence: 53%

The timed up and go test in idiopathic normal pressure hydrocephalus: a Nationwide Study of 1300 patients

Sundström

Rydja

Virhammar

et al. 2022

Fluids Barriers CNS

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“…Third, EncephaLog provides nine additional biomarkers to the gold standard TUG outcome, objectively and quantitatively expanding the clinical coverage of gait biomarkers. Rotation time and step length provide information on medication-induced dyskinesia that worsens PD patients’ gait [26,48] and are used for assessing PD progression (characterized by slower rotation and smaller step length [12]). Elders and those with Parkinson’s disease who fall have a tendency toward a lower cadence, especially when combined with shorter stride [49,50].…”

Section: Discussionmentioning

confidence: 99%

“…On top of the TUG completion time, iTUG output includes the duration of TUG phases (Stand-Up, Walk-Away, Rotation, Walk-Back, and Sit-Down), as well as non-temporal parameters including step-related biomarkers and more [18,19,20,21,22,23,24,25]. iTUG’s higher accuracy in comparison to subjective evaluation has proven to be more sensitive to pathologies, useful in fall risk prediction [12,19,23,24,26,27], helpful in the evaluation of responses to therapeutic interventions [17,26], and can even provide cognitive related indicators [24,26,28].…”

Section: Introductionmentioning

confidence: 99%

Pilot Study of the EncephaLog Smartphone Application for Gait Analysis

Tchelet¹,

Stark‐Inbar²,

Yekutieli³

2019

Sensors

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Gait disorders and falls are common in elders and in many clinical conditions, yet they are typically infrequently and subjectively evaluated, limiting prevention and intervention. Completion-time of the Timed-Up-and-Go (TUG) test is a well-accepted clinical biomarker for rating mobility and prediction of falls risk. Using smartphones’ integral accelerometers and gyroscopes, we already demonstrated that TUG completion-time can be accurately measured via a smartphone app. Here we present an extended app, EncephaLogTM, which provides gait analysis in much more detail, offering 9 additional gait biomarkers on top of the TUG completion-time. In this pilot, four healthy adults participated in a total of 32 TUG tests; simultaneously recorded by EncephaLog and motion sensor devices used in movement labs: motion capture cameras (MCC), pressure mat; and/or wearable sensors. Results show high agreement between EncephaLog biomarkers and those measured by the other devices. These preliminary results suggest that EncephaLog can provide an accurate, yet simpler, instrumented TUG (iTUG) platform than existing alternatives, offering a solution for clinics that cannot afford the cost or space required for a dedicated motion lab and for monitoring patients at their homes. Further research on a larger study population with pathologies is required to assess full validity.

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“…The mean age at diagnosis is approximately 70 years (3). A shunt insertion, where CSF is drained from the ventricles, is effective and the result can be compared with the effect of levodopa medication in Parkinson´s disease (4). Approximately three-quarter of the patients improve after surgery, and the most pronounced effect is on gait performance (5,6).…”

Section: Introductionmentioning

confidence: 99%

Evaluating the Cerebrospinal Fluid Tap Test With the Hellström iNPH Scale for Patients With Idiopathic Normal Pressure Hydrocephalus – a Retrospective Cohort Study of 132 Patients

Rydja¹,

Eleftheriou²,

Lundin³

2020

Preprint

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Background The cerebrospinal fluid tap test (CSF TT) is used for selecting shunt surgery candidates in idiopathic normal pressure hydrocephalus (iNPH). Variations in performance, and different outcome measures and cut-off levels in previous research on the CSF TT make comparison of accuracy difficult between studies. We aimed to evaluate the CSF TT, by using the Hellström iNPH scale for shunted iNPH patients with a standardized method. Methods One hundred thirty-two shunt operated iNPH patients were retrospectively included in this study. The gait and balance domains in the iNPH scale were used as outcome measures for the CSF TT and the total iNPH scale score as postoperatively outcome. To identify responders a cut-off level ≥ 5 points was used. Differences between responders and non-responders to the CSF TT, as well as the sensitivity, speciﬁcity, positive and negative predictive values, accuracy and correlations between outcomes of the CSF TT and postoperatively were calculated. Results In the gait domain, there were 62.9% responders and correspondingly 42.7 % in the balance domain of the CSF TT. CSF TT responders had significantly better outcomes in both the gait and balance domains but not in the neuropsychology or continence domains postoperatively. The sensitivity and specificity of the CSF TT and the outcome of the total iNPH scale score postoperatively were 67.6% and 53.3% for gait and 47.5% and 73.3% for balance. For age ≥ 80 years, the sensitivity and specificity for gait were 52.2% and 60.0%, and for age ≤ 80 years 72.2% and 50.0%. Gait as an outcome measure for both the CSF TT and postoperatively had the highest sensitivity, (73.2%) and specificity (65.7%) for all ages. Conclusions The CSF TT, with Hellström´s iNPH scale as the outcome measure, has clear limitations in predicting postoperative results. The gait domain may be used to detect changes of outcomes in gait, but the balance domain is too insensitive to use as an assessment for the CSF TT. The value of the CFS TT for patients over 80 years of age appears to be even lower. Differential diagnostic considerations together with radiological assessments remain cornerstones in selecting eligible shunt responders.

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Dopaminergic and non-dopaminergic gait components assessed by instrumented timed up and go test in Parkinson’s disease

Cited by 12 publications

References 42 publications

The timed up and go test in idiopathic normal pressure hydrocephalus: a Nationwide Study of 1300 patients

The timed up and go test in idiopathic normal pressure hydrocephalus: a Nationwide Study of 1300 patients

Pilot Study of the EncephaLog Smartphone Application for Gait Analysis

Evaluating the Cerebrospinal Fluid Tap Test With the Hellström iNPH Scale for Patients With Idiopathic Normal Pressure Hydrocephalus – a Retrospective Cohort Study of 132 Patients

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