The effects of dual-task in patients with Parkinson's disease performing cognitive-motor paradigms.

Patients with Parkinson's disease (PD) exhibit impaired dual-task (DT) performance. A recent meta-analysis confirmed that dual tasking severely affects walking performance in PD patients. However, one report indicated that a cycling DT paradigm has facilitative effects on cognition. We investigated the effects of dual tasking by using walking and cycling as motor tasks and revealed the clinical determinants associated with DT performance. Twenty-seven eligible participants were enrolled for clinical, cognitive-walking, and cognitive-cycling DT paradigm investigations. The mean age and age at onset of the patients were 59.87 ± 6.3 and 53.11 ± 8.4 years, respectively. Both the off- and on-state akinesia subscores were worse on the more-affected side than on the less-affected side. However, the DT effects on the cycling and gait outcomes on both the more-affected and the less-affected side showed no significant differences. The DT effect on the two motor tasks and cognitive performance during a concurrent walking task declined. Nevertheless, the DT effect on cognition improved during cycling. The present study also revealed that the levodopa equivalent daily dosage was highly associated with cognitive-cycling performance and that the akinesia subscore was the most relevant factor that contributed to cognitive-walking performance. In conclusion, DT facilitation or interference might be mediated by the type of motor task applied. The cognitive-cycling DT paradigm had a facilitative effect on cognition. Cycling exercise may diminish motor dysfunction has been investigated. We suggest that cognitive-cycling DT training is a potential adjuvant therapeutic strategy for patients with PD to promote motor and cognitive functions.

Combined Assessment of Serum Alpha-Synuclein and Rab35 is a Better Biomarker for Parkinson's Disease

BACKGROUND AND PURPOSE: It is essential to develop a reliable predictive serum biomarker for Parkinson's disease (PD). The accumulation of alpha-synuclein (αSyn) and up-regulated expression of Rab35 participate in the etiology of PD. The purpose of this investigation was to determine whether the combined assessment of serum αSyn and Rab35 is a useful predictive biomarker for PD. METHODS: Serum levels of αSyn or Rab35 were determined in serum samples from 59 sporadic PD patients, 19 progressive supranuclear palsy (PSP) patients, 20 multiple system atrophy (MSA) patients, and 60 normal controls (NC). Receiver operating characteristics (ROC) curves were calculated to determine the diagnostic accuracy of αSyn or/and Rab35 in discriminating PD patients from NC or atypical parkinsonian patients. RESULTS: The levels of αSyn and Rab35 were increased in PD patients. The serum level of Rab35 was positively correlated with that of αSyn in PD patients. Compared to analyzing αSyn or Rab35 alone, the combined analysis of αSyn and Rab35 produced a larger area under the ROC curve and performed better in discriminating PD patients from NC, MSA patients, or PSP patients. When age was dichotomized at 55, 60, 65, or 70 years, the combined assessment of αSyn and Rab35 for classifying PD was better in the group below the cutoff age than in the group above the cutoff age. CONCLUSIONS: Combined assessment of serum αSyn and Rab35 is a better biomarker for discriminating PD patients from NC or atypical parkinsonian patients, and is a useful predictive biomarker for younger sporadic PD patients.

An 8-Week Low-Intensity Progressive Cycling Training Improves Motor Functions in Patients with Early-Stage Parkinson's Disease

BACKGROUND AND PURPOSE: The effects of high-intensity cycling as an adjuvant therapy for early-stage Parkinson's disease (PD) were highlighted recently. However, patients experience difficulties in maintaining these cycling training programs. The present study investigated the efficacy of cycling at a mild-to-moderate intensity in early-stage PD. METHODS: Thirteen PD patients were enrolled for 16 serial cycling sessions over a 2-month period. Motor function was assessed using the Unified Parkinson's Disease Rating Scale part III (UPDRS III) and Timed Up and Go (TUG) test as primary outcomes. The Montreal Cognitive Assessment (MoCA), modified Hoehn and Yahr Stage (mHYS), total UPDRS, Falls Efficacy Scale, New Freezing of Gait Questionnaire, Schwab and England Activities of Daily Living, 39-item Parkinson's Disease Questionnaire, Patient Global Impression of Change, and gait performance were assessed as secondary outcomes. RESULTS: The age and the age at onset were 59.67±7.24 and 53.23±10.26 years (mean±SD), respectively. The cycling cadence was 53.27±8.92 revolutions per minute. The UPDRS III score improved significantly after 8 training sessions (p=0.011) and 16 training sessions (T2) (p=0.001) in the off-state, and at T2 (p=0.004) in the on-state compared to pretraining (T0). The TUG duration was significantly shorter at T2 than at T0 (p < 0.05). The findings of MoCA, total UPDRS, double limb support time, and mHYS (in both the off- and on-states) also improved significantly at T2. CONCLUSIONS: Our pioneer study has demonstrated that a low-intensity progressive cycling exercise can improve motor function in PD, especially akinesia. The beneficial effects were similar to those of high-intensity rehabilitation programs.