Evaluation of ActiTrac (ambulatory activity monitor) in Parkinson's Disease.

At present, the evaluation of Parkinson's Disease (PD) relies mainly on Unified Parkinson's Disease Rating Scale (UPDRS). Other objective measures have been proposed, including functional studies, timed tests and ambulatory activity monitors (AAM). We carried out a prospective study to analyze the utility and correlation of the AAM: ActiTrac with UPDRS scores and timed tests in patients with PD. We studied 28 patients with idiopathic PD (age: 62 +/- 11 years; duration of illness: 7.7 +/- 4.4 years; clinical stage 2.3 +/- 0.39). Motor evaluation included UPDRS and five timed tests: Purdue Pegboard test and those proposed in CAPIT protocol, pronation-supination (PS), finger dexterity (FD), movement between two points (MTP) and walking test (WT). Clinical evaluation was performed in off condition, at 9 a.m., (12h off their medication). Finally, ActiTrac was placed on the wrist (more affected side) continuously for at least 72h. ActiTrac activity was correlated (Spearman) with total UPDRS (r: - 0.53, p < 0.005) and motor UPDRS (r:- 0.46, p: 0.01); UPDRS rigidity subscore (r:- 0.52, p < 0.01); UPDRS bradykinesia subscore (r:- 0.48; p:0.01); FD (r: - 0.47 p: 0.01), WT (r: - 0.49, p < 0.01) and Purdue test (r:0.54; p < 0.01). ActiTrac seems to be a reasonably accurate method to evaluate motor activity in PD.

Evaluation of timed tests in advanced Parkinsonian patients who were candidates for subthalamic stimulation.

UNLABELLED: The evaluation of Parkinson disease relies on the use of clinical scales, mainly the UPDRS. However, especially for those candidates for functional surgery, other objective methods are also considered, including the use of timed tests. METHODS: The authors studied the motor performance of 33 patients with advanced Parkinson disease (PD) who were candidates for subthalamic nucleus (STN) stimulation. Presurgical motor evaluation included UPDRS and the 4 timed tests of the CAPIT protocol, including pronation-supination (PS), finger dexterity (FD), movement between 2 points (MTP), and the walking test (WT). A clinical evaluation was performed during patients' OFF condition and during their best ON state. Fifteen patients were implanted with STN stimulation and were evaluated at 6 months with the same protocol described for the presurgical evaluation. RESULTS: At baseline, all 4 timed tests significantly correlated with total and motor UPDRS scores, in the OFF and ON states, especially MTP. All timed tests, save WT, significantly improved after surgery in the OFF state (especially MTP; P = 0.002). After surgery, all timed tests, save FD, significantly correlated with total and motor UPDRS scores in the OFF state. Timed tests, especially MTP, maintained an excellent correlation with UPDRS in both OFF and ON states before and after surgery.

Motor complications in Parkinson disease: a prospective follow-up study.

Currently, Parkinson disease (PD) can be symptomatically controlled with standard treatments; however, after a few years this response typically declines. The authors carried out a prospective practice-based study to evaluate the evolution and motor complications during the first 5 years in 59 de novo PD patients. They observed a significant improvement in UPDRS scores during the first year, then the UPDRS mean score declined progressively, especially after the third year (UPDRS score at baseline, 27 points; year 1, 19 points; year 2, 20.3 points; year 3, 22.6 points; year 4, 24.9 points; year 5, 29.5 points). Motor fluctuations, dyskinesias, and freezing also increased after year 3 from 10%, 16%, and 8% respectively to 35%, 32%, and 27% at year 5. At 5 years, 50% of patients (30 of 59) still had UPDRS scores better or equal to baseline, and 44% (26 of 59) had no motor complications. This latter group represented 38% of those subjects initially treated with levodopa and 52% initially treated with other agents.

Bradykinesia in Huntington's disease. A prospective, follow-up study.

Bradykinesia is a frequent finding in Huntington's disease (HD), but some aspects are presently unknown; including the natural evolution of bradykinesia over time and the correlation between bradykinesia and functional capacity. We studied the motor performance of 20 genetically confirmed patients with HD (age: 40+/-10.8 years; age at onset 33.6+/-11 years; total functional capacity (TFC): 9.57+/-3; UHDRS total motor scale: 31.4+/-13, triplet length (CAG)n: 46.7+/-4 triplets). These patients were studied in baseline conditions and after 18.7+/-6 months of follow-up. In addition, HD patients were compared with 20 age-matched normal controls. Motor study included the four CAPIT timed tests commonly used for Parkinson's disease: pronation-supination (PS), finger dexterity (FD), movement between two points (MTP) and walking test (WT). HD patients were significantly slower than controls in all motor tasks. A significant deterioration occurred over time in three of the four motor tasks (especially FD and WT). A significant correlation between timed tests and TFC score was found (for MTP, r: -0.845; p < 0,0001). In addition a significant correlation between timed tests and the UHDRDS total motor scale was also found (for MTP, r: 0.864; p < 0.0001). In conclusion, simple timed motor tests can detect a deterioration of motor activity over time in HD. Timed tests might be useful to follow the natural evolution of HD and to assess the efficacy of new therapies.