Exp Brain Res DOI 10.1007/s00221-013-3778-8
Research Article
Identifying axial and cognitive correlates in patients with Parkinson’s disease motor subtype using the instrumented Timed Up and Go Talia Herman · Aner Weiss · Marina Brozgol · Nir Giladi · Jeffrey M. Hausdorff
Received: 13 June 2013 / Accepted: 12 November 2013 © Springer-Verlag Berlin Heidelberg 2013
Abstract Parkinson’s disease (PD) is clinically highly heterogeneous, often divided into tremor dominant (TD) and postural instability gait difficulty (PIGD). To better understand these subtypes and to help stratify patients, we applied an objective marker, i.e., an instrumented version of the traditional “Timed Up and Go” test (iTUG). It is not known whether the iTUG is sensitive to PD motor phenotypes or what are its behavioral and cognitive correlates. Subjects performed the iTUG wearing a body-fixed sensor. Subcomponents were studied including walking, transitions and turning. Gait, balance and cognitive function and Electronic supplementary material The online version of this article (doi:10.1007/s00221-013-3778-8) contains supplementary material, which is available to authorized users. T. Herman · A. Weiss · M. Brozgol · N. Giladi · J. M. Hausdorff (*) Laboratory for Gait and Neurodynamics, Movement Disorders Unit, Department of Neurology, Tel-Aviv Sourasky Medical Center, 6 Weizman Street, 64239 Tel Aviv, Israel e-mail: [email protected] T. Herman Sackler Faculty of Medicine, The Dr. Miriam and Sheldon G. Adelson Graduate School of Medicine, Tel Aviv University, Tel Aviv, Israel N. Giladi Department of Neurology, Sackler Faculty of Medicine and Sagol School of Neuroscience, Tel-Aviv University, Tel Aviv, Israel J. M. Hausdorff Department of Physical Therapy, Sackler School of Medicine and Sagol School of Neuroscience, Tel-Aviv University, Tel Aviv, Israel J. M. Hausdorff Department of Medicine, Harvard Medical School, Boston, MA, USA
the associations between iTUG, behavioral and cognitive domains were assessed. We also compared two representative subtypes, with minimal symptom overlap, referred to here as predominant PIGD (p-PIGD) and predominant TD (p-TD). One hundred and six patients with PD performed the iTUG. Significant correlations were found between iTUG measures and the PIGD score, but not with TD score. Thirty p-PIGD and 31 p-TD patients were identified. Both groups were similar with respect to age and disease duration (p > 0.75). The p-PIGD patients took significantly longer to complete the iTUG (p = 0.026), used more steps (p = 0.031), albeit with similar step duration (p = 0.936). In the sit-to-stand transition, the p-PIGD patients exhibited lower anterior–posterior jerk (p = 0.04) and lower pitch range (p = 0.012). During the turn, the p-PIGD patients had a lower yaw amplitude (p
Research Article
Identifying axial and cognitive correlates in patients with Parkinson’s disease motor subtype using the instrumented Timed Up and Go Talia Herman · Aner Weiss · Marina Brozgol · Nir Giladi · Jeffrey M. Hausdorff
Received: 13 June 2013 / Accepted: 12 November 2013 © Springer-Verlag Berlin Heidelberg 2013
Abstract Parkinson’s disease (PD) is clinically highly heterogeneous, often divided into tremor dominant (TD) and postural instability gait difficulty (PIGD). To better understand these subtypes and to help stratify patients, we applied an objective marker, i.e., an instrumented version of the traditional “Timed Up and Go” test (iTUG). It is not known whether the iTUG is sensitive to PD motor phenotypes or what are its behavioral and cognitive correlates. Subjects performed the iTUG wearing a body-fixed sensor. Subcomponents were studied including walking, transitions and turning. Gait, balance and cognitive function and Electronic supplementary material The online version of this article (doi:10.1007/s00221-013-3778-8) contains supplementary material, which is available to authorized users. T. Herman · A. Weiss · M. Brozgol · N. Giladi · J. M. Hausdorff (*) Laboratory for Gait and Neurodynamics, Movement Disorders Unit, Department of Neurology, Tel-Aviv Sourasky Medical Center, 6 Weizman Street, 64239 Tel Aviv, Israel e-mail: [email protected] T. Herman Sackler Faculty of Medicine, The Dr. Miriam and Sheldon G. Adelson Graduate School of Medicine, Tel Aviv University, Tel Aviv, Israel N. Giladi Department of Neurology, Sackler Faculty of Medicine and Sagol School of Neuroscience, Tel-Aviv University, Tel Aviv, Israel J. M. Hausdorff Department of Physical Therapy, Sackler School of Medicine and Sagol School of Neuroscience, Tel-Aviv University, Tel Aviv, Israel J. M. Hausdorff Department of Medicine, Harvard Medical School, Boston, MA, USA
the associations between iTUG, behavioral and cognitive domains were assessed. We also compared two representative subtypes, with minimal symptom overlap, referred to here as predominant PIGD (p-PIGD) and predominant TD (p-TD). One hundred and six patients with PD performed the iTUG. Significant correlations were found between iTUG measures and the PIGD score, but not with TD score. Thirty p-PIGD and 31 p-TD patients were identified. Both groups were similar with respect to age and disease duration (p > 0.75). The p-PIGD patients took significantly longer to complete the iTUG (p = 0.026), used more steps (p = 0.031), albeit with similar step duration (p = 0.936). In the sit-to-stand transition, the p-PIGD patients exhibited lower anterior–posterior jerk (p = 0.04) and lower pitch range (p = 0.012). During the turn, the p-PIGD patients had a lower yaw amplitude (p
