- Email: [email protected]
P2.099 Gait strategy comparison in Parkinson's disease and Progressive Supranuclear Palsy using gait analysis
S68
Poster Session II
needed into the (in)ability of patients to improve their physical activity levels.
patients and carers independently, with and without a short video showing episodes of FOG of varying duration. Results: Patients and carers of similar age and cognitive status were recruited in three Movement Disorders centres (B, UK, IL). Patients displayed very high agreement between pre- and post-video self-categorisation as a freezer or a non-freezer (Kappa = 0.91). Carers were less certain, as ten participants changed their opinion after seeing the video (Kappa = 0.78). Post-video total scores in the 69 freezers showed high agreement between patients and carers (ICC = 0.90 [0.85;0.93]). Principal component analysis identified 3 dimensions with eigen-values above 1.0, explaining 72% of the variance: (1) overall rating of FOG; (2) FOG frequency and (3) FOG impact on daily life. Conclusion: Video observation improved recognition of FOG, especially for carers. The NFOG-Q with video is a valid and clinically relevant outcome measure of freezing for both patients and carers and allows analysis of separate dimensions of FOG (frequency and impact on daily life).
Physical activity levels in PD patients compared to controls.
Psychiatric disorders associated with gait and mental dysfunction P2.097 The relationship between fatigue, cardio-respiratory fitness and quality of life with stroke patients C. Van Walle, L. Vereeck, W. Saeys° , C. Lafosse, G. Dupain, C. Sneyers Antwerp, Belgium Background: In clinical practice, fatigue is known to frequently occur after stroke, and physical and cognitive symptoms of the stroke may be accentuated when patients are fatigued. In addition stroke patients have decreased aerobic capacity, but its relation with pathological fatigue is unknown. This study examines the relationship between cardiorespiratory fitness and pathological fatigue. Secondary, the influence of cardio-respiratory fitness or fatigue on quality of life is being investigated. Methods: Physical condition was measured in 19 individuals using a bicycle ergometer. The Dutch Modified Fatigue Impact Scale (DMFIS), Stroke Impact Scale (SIS-16) and the Medical Outcomes Study Short-Form General Health Survey (SF36) were used to assess fatigue and quality of life. All tests took place within one week. Results: No correlation was found between fatigue and cardiorespiratory fitness. The total score of the DMFIS correlated significantly with the subscales memory (r = −0.48, p < 0.05), emotion (r = −0.29, p < 0.05) and social life (r = −0.30, p < 0.05) of the SIS, but these correlations are quite low. The SF36 total score (r = −0.55, p < 0.05) correlated moderately with fatigue. Conclusion: Cardio-respiratory fitness has no influence on pathological fatigue nor on quality of life with stroke patients. The relationship between fatigue and quality of life is moderate. Because of the limited number of patients these results have to be interpreted with caution.
P2.097a The new revised freezing of gait questionnaire, a reliable and valid instrument to measure freezing in Parkinson’s disease? A. Nieuwboer1° , T. Herman2 , L. Rochester3 , G. Ehab Emil1 , N. Giladi2 Belgium; 2 Tel-Aviv, Israel; 3 Glasgow, Scotland
1 Heverlee,
Background and Aims: The validity of the new Freezing of Gait Questionnaire (NFOG-Q) was examined by comparing patients’ self-reported outcomes with those of carers before and after watching a video. It also explored the validity of measuring separate dimensions of FOG. Methods: A group of 102 patients with PD and their carers participated. Part I of the NFOG-Q categorised individuals as a freezer or non-freezer. Subsequently, only freezers completed part II (FOG severity) and III (impact on daily life) of the scale. The NFOG-Q was administered to
P2.098 Depression and falls among community dwelling elderly people L. Aharony° , P. Sela-Katz, A. Iavzuri-Erel, I. Carmon, I. Shugaiev Haifa, Israel Background and Aims: Depression and falls are two common conditions at old age, relatively under-diagnosed and under-treated, that have major impact on health and quality of life. Comprehensive Geriatric Assessment (CGA) is a multidimensional interdisciplinary diagnostic process that is an established practice in Geriatrics. Study aim was to evaluate results of CGA applied to frail elders with multiple problems referred to a community geriatric clinic and look for relationship between depression and falls. Method: This was a retrospective evaluation of 101 elders who were evaluated by CGA and found to have depression. A coordinated and integrated plan was generated for each patient including stopping irrelevant medications, use of antidepressants, family education, and use of community resources. Results: Average age 81.5; recurrent falls in past year were reported by 67%; 52.5% were diagnosed with dementia. Additional 18.8% had cognitive decline. Women were 60% of the sample. On follow up, 55.4% reported improvement in mood and wellbeing. 63.4% reported no-falls. Decreased number of falls was reported by additional 3%. There was correlation between general improvement, falls and adherence to medical and social recommendations. Conclusions: 1. Successful approach to elders’ falls must include CGA followed by multi-factorial interventions including special attention to depression. 2. Environmental and social interventions and family education are required in conjunction with medical intervention for treating depression and falls of elders. 3. Our results supported the relationship between falls and depression. In clinical practice more attention should be given to old fallers concerning diagnosis and treatment of associated depression. P2.099 Gait strategy comparison in Parkinson’s disease and Progressive Supranuclear Palsy using gait analysis G. Albertini1° , M. Galli1,2 , V. Cimolin2 , F. De Pandis2 , P. Onorati2 Italy
1 Rome, 2 Milan,
Background and Aims: Gait Analysis (GA) has been used to elucidate characteristic features of neurological gait disturbances. Although some
Psychiatric disorders associated with gait and mental dysfunction
S69
studies compared single patient groups with controls, there are only a few studies comparing gait between patients with different neurological disorders affecting gait. This study compared gait parameters of patients with Parkinson’s disease (PD) to those of subjects with Progressive Supranuclear Palsy (PSP). Methods: 4 subjects with PD and 4 subjects with PSP were evaluated using a 9-camera optoelectronic system (SMART, BTS, Italy), two force plates (Kistler, CH), and a video system (VideoController, BTS, Italy). 10 healthy subjects was considered as controls. The gait of the two pathological states were characterised quantitatively with indices from GA. Results: All patients showed slower velocity of progression and reduced step length compared with healthy controls. As concerns kinematic strategy, the main differences appeared more at proximal joints rather than at distal joints. Patients with PSP pointed out in fact pelvic tilt in a more anterior position than subjects with PD; as concerns hip strategy, both pathological groups revealed reduced range of motion, but PSP patients displayed a more accentuated hip flexion than PD during all gait cycle. No differences were found at knee and ankle joints. Conclusions: GA revealed to be useful in order to make a distinction the DP and PSP gait strategy and the obtained results may be help in the differentiation of PSP in the clinical practise in order to define more effective treatment and rehabilitative programs for these subjects.
cognitive decline. This study investigated whether an improvement in cognitive ability in elders with a known cognitive disorder (depression) resulted in improved dual task performance during balance and gait tasks. Methods: Twelve adults aged over 65 yrs diagnosed with clinical depression (DSSM-IV criteria) admitted to a psychogeriatric inpatient facility and twelve age- and gender-matched controls performed several clinical and laboratory tests of balance and gait under single and dual task conditions. Depressed elders were tested pre and post electroconvulsive therapy (ECT) or antidepressants and controls were tested at a matched time period. Tests included the Geriatric Depression Scale (GDS), Timed Up and Go (TUG) test performed alone and with added tasks, and centre of pressure (COP) excursion in stance with several added cognitive tasks. Results: Pre intervention, depressed elders performed more poorly than controls in single and dual task balance and gait measures. Post intervention, depressed elders significantly improved in their affective state (p < 0.001), and single and dual task TUG speed (p < 0.03, range improvement 4−14s), whereas control subjects showed no change. There were fewer changes in COP excursion post intervention. Conclusions: These results suggest that dual task interference with postural control may be related to the cognitive changes occurring with improvement in depression, but that this may be dependent on the postural task performed.
P2.100 Objective evaluation of gait parameters and psychomotor retardation in Major Depression
P2.102 Gait dysfunction in Williams syndrome: is there evidence for cerebellar involvement?
S. Aybek1° , A. Berney2 , A. Salarian3 , S. Valloton2 , K. Amininan3 , F.J.G. Vingerhoets1 Lausanne, Switzerland
D.R. Hocking1° , J.L. Bradshaw1 , J. McGinley2 , N.J. Rinehart1 1 Clayton, VIC, 2 Parkville, Australia
Background and Aims: Psychomotor retardation is part of Major Depression (MD) diagnosis criteria and has been assimilated to bradykinesia, eventhough its mechanisms are unknown. We conducted a pilot study to evaluate gait parameters, bradykinesia and posture in MD patients with an ambulatory system, allowing objective measurements. Methods: Our recently validated wireless autonomous ambulatory system, containing miniature gyroscopes, data-logger, battery and flash memory, allows to record hand movements [speed, amplitude and activity (% of time with movement)], posture (% of time standing, walking, lying or sitting) and gait parameters (speed, cadence, stance, double support, stride). Four patients with DSM-IV MD (age 58±11 y) and seven healthy controls (age 62±10 y) were asked to carry on with their usual activities while being recorded for 6 hours continuously. Results: Hands activity was significantly lower in MD (MD: 40%, controls: 60%; p < 0.05). Speed (p = 0.13) and amplitude (p = 0.71) of hand movements were similar to controls. MD patients had a trend to spend more time lying or sitting than controls (p = 0.06) but did not differ in terms of gait parameters. Conclusion: Using our newly validated ambulatory long-term monitoring system, we found that patients with MD displayed less hand movements than controls and tended to spend more time lying or sitting over 6 hours, but did not differ in terms of speed and amplitude of movement, nor in gait parameters. This suggests that psychomotor retardation described in MD might be the expression of paucity of movement rather than bradykinesia as in parkinsonism and might involved different (non-dopaminergic) mechanisms.
P2.101 Gait and dual tasking dysfunction improves with ECT or antidepressants in depressed elders S. Clewett° , S.G. Brauer, A. Broome Brisbane, Australia Background and Aims: Cognitive resources are required for gait and standing balance, with a reduction in dual task performance during these postural tasks demonstrated in previous studies of older adults with
Williams syndrome (WS) is a rare genetically-based neurodevelopmental disorder characterised by delayed development, intellectual disability and a distinctive cognitive profile. Relative to the cognitive characteristics of WS, there is a dearth of research into the movement problems in this disorder. The few clinical reports of motor problems in WS have described neurologic signs of cerebellar dysfunction such as poor balance during cerebellar sensitization tasks. However, the precise loci for the motor impairments seen in WS are as yet unclear. This study is the first to examine spatiotemporal gait characteristics in WS, the purpose of which was to examine the impact of externally imposed demands (walking speed) on gait functioning. The GAITRite walkway was used to analyse gait patterns and gait variability in children and adults with WS and healthy age- and gender-matched controls. The results were consistent with the findings from patients with cerebellar ataxia. The WS group showed reduced stride length and speed, wide base of support, a compromised ability to walk in a straight line, and higher stepto-step variability in stride and speed when compared to matched controls. However, the gait characteristics of basal ganglia impairment may overlap with cerebellar dysfunction in WS, since the reduced speed and stride length and increased stride length variability without disturbances to rhythmic timing (cadence) observed in the WS group is consistent with Parkinsonian gait. An explanation for these findings is provided which suggests that motor problems in WS might reflect abnormal neural connectivity between these two networks.
P2.103 Differential diagnosis of pseudodementia in primary care settings K. Kosma1° , A. Sianni1 , A. Ganotopoulou2 , N. Karagianni1 Greece
1 Athens, 2 Volos,
Introduction: A proportion of elderly patients suffering of depression may present symptoms of cognitive deterioration that can difficult be differentiated from true dementia. These subjects often show poor performance in commonly used screening tests for dementia which comes in contrast to their usual normal level of functioning. This condition is named
Poster Session II
needed into the (in)ability of patients to improve their physical activity levels.
patients and carers independently, with and without a short video showing episodes of FOG of varying duration. Results: Patients and carers of similar age and cognitive status were recruited in three Movement Disorders centres (B, UK, IL). Patients displayed very high agreement between pre- and post-video self-categorisation as a freezer or a non-freezer (Kappa = 0.91). Carers were less certain, as ten participants changed their opinion after seeing the video (Kappa = 0.78). Post-video total scores in the 69 freezers showed high agreement between patients and carers (ICC = 0.90 [0.85;0.93]). Principal component analysis identified 3 dimensions with eigen-values above 1.0, explaining 72% of the variance: (1) overall rating of FOG; (2) FOG frequency and (3) FOG impact on daily life. Conclusion: Video observation improved recognition of FOG, especially for carers. The NFOG-Q with video is a valid and clinically relevant outcome measure of freezing for both patients and carers and allows analysis of separate dimensions of FOG (frequency and impact on daily life).
Physical activity levels in PD patients compared to controls.
Psychiatric disorders associated with gait and mental dysfunction P2.097 The relationship between fatigue, cardio-respiratory fitness and quality of life with stroke patients C. Van Walle, L. Vereeck, W. Saeys° , C. Lafosse, G. Dupain, C. Sneyers Antwerp, Belgium Background: In clinical practice, fatigue is known to frequently occur after stroke, and physical and cognitive symptoms of the stroke may be accentuated when patients are fatigued. In addition stroke patients have decreased aerobic capacity, but its relation with pathological fatigue is unknown. This study examines the relationship between cardiorespiratory fitness and pathological fatigue. Secondary, the influence of cardio-respiratory fitness or fatigue on quality of life is being investigated. Methods: Physical condition was measured in 19 individuals using a bicycle ergometer. The Dutch Modified Fatigue Impact Scale (DMFIS), Stroke Impact Scale (SIS-16) and the Medical Outcomes Study Short-Form General Health Survey (SF36) were used to assess fatigue and quality of life. All tests took place within one week. Results: No correlation was found between fatigue and cardiorespiratory fitness. The total score of the DMFIS correlated significantly with the subscales memory (r = −0.48, p < 0.05), emotion (r = −0.29, p < 0.05) and social life (r = −0.30, p < 0.05) of the SIS, but these correlations are quite low. The SF36 total score (r = −0.55, p < 0.05) correlated moderately with fatigue. Conclusion: Cardio-respiratory fitness has no influence on pathological fatigue nor on quality of life with stroke patients. The relationship between fatigue and quality of life is moderate. Because of the limited number of patients these results have to be interpreted with caution.
P2.097a The new revised freezing of gait questionnaire, a reliable and valid instrument to measure freezing in Parkinson’s disease? A. Nieuwboer1° , T. Herman2 , L. Rochester3 , G. Ehab Emil1 , N. Giladi2 Belgium; 2 Tel-Aviv, Israel; 3 Glasgow, Scotland
1 Heverlee,
Background and Aims: The validity of the new Freezing of Gait Questionnaire (NFOG-Q) was examined by comparing patients’ self-reported outcomes with those of carers before and after watching a video. It also explored the validity of measuring separate dimensions of FOG. Methods: A group of 102 patients with PD and their carers participated. Part I of the NFOG-Q categorised individuals as a freezer or non-freezer. Subsequently, only freezers completed part II (FOG severity) and III (impact on daily life) of the scale. The NFOG-Q was administered to
P2.098 Depression and falls among community dwelling elderly people L. Aharony° , P. Sela-Katz, A. Iavzuri-Erel, I. Carmon, I. Shugaiev Haifa, Israel Background and Aims: Depression and falls are two common conditions at old age, relatively under-diagnosed and under-treated, that have major impact on health and quality of life. Comprehensive Geriatric Assessment (CGA) is a multidimensional interdisciplinary diagnostic process that is an established practice in Geriatrics. Study aim was to evaluate results of CGA applied to frail elders with multiple problems referred to a community geriatric clinic and look for relationship between depression and falls. Method: This was a retrospective evaluation of 101 elders who were evaluated by CGA and found to have depression. A coordinated and integrated plan was generated for each patient including stopping irrelevant medications, use of antidepressants, family education, and use of community resources. Results: Average age 81.5; recurrent falls in past year were reported by 67%; 52.5% were diagnosed with dementia. Additional 18.8% had cognitive decline. Women were 60% of the sample. On follow up, 55.4% reported improvement in mood and wellbeing. 63.4% reported no-falls. Decreased number of falls was reported by additional 3%. There was correlation between general improvement, falls and adherence to medical and social recommendations. Conclusions: 1. Successful approach to elders’ falls must include CGA followed by multi-factorial interventions including special attention to depression. 2. Environmental and social interventions and family education are required in conjunction with medical intervention for treating depression and falls of elders. 3. Our results supported the relationship between falls and depression. In clinical practice more attention should be given to old fallers concerning diagnosis and treatment of associated depression. P2.099 Gait strategy comparison in Parkinson’s disease and Progressive Supranuclear Palsy using gait analysis G. Albertini1° , M. Galli1,2 , V. Cimolin2 , F. De Pandis2 , P. Onorati2 Italy
1 Rome, 2 Milan,
Background and Aims: Gait Analysis (GA) has been used to elucidate characteristic features of neurological gait disturbances. Although some
Psychiatric disorders associated with gait and mental dysfunction
S69
studies compared single patient groups with controls, there are only a few studies comparing gait between patients with different neurological disorders affecting gait. This study compared gait parameters of patients with Parkinson’s disease (PD) to those of subjects with Progressive Supranuclear Palsy (PSP). Methods: 4 subjects with PD and 4 subjects with PSP were evaluated using a 9-camera optoelectronic system (SMART, BTS, Italy), two force plates (Kistler, CH), and a video system (VideoController, BTS, Italy). 10 healthy subjects was considered as controls. The gait of the two pathological states were characterised quantitatively with indices from GA. Results: All patients showed slower velocity of progression and reduced step length compared with healthy controls. As concerns kinematic strategy, the main differences appeared more at proximal joints rather than at distal joints. Patients with PSP pointed out in fact pelvic tilt in a more anterior position than subjects with PD; as concerns hip strategy, both pathological groups revealed reduced range of motion, but PSP patients displayed a more accentuated hip flexion than PD during all gait cycle. No differences were found at knee and ankle joints. Conclusions: GA revealed to be useful in order to make a distinction the DP and PSP gait strategy and the obtained results may be help in the differentiation of PSP in the clinical practise in order to define more effective treatment and rehabilitative programs for these subjects.
cognitive decline. This study investigated whether an improvement in cognitive ability in elders with a known cognitive disorder (depression) resulted in improved dual task performance during balance and gait tasks. Methods: Twelve adults aged over 65 yrs diagnosed with clinical depression (DSSM-IV criteria) admitted to a psychogeriatric inpatient facility and twelve age- and gender-matched controls performed several clinical and laboratory tests of balance and gait under single and dual task conditions. Depressed elders were tested pre and post electroconvulsive therapy (ECT) or antidepressants and controls were tested at a matched time period. Tests included the Geriatric Depression Scale (GDS), Timed Up and Go (TUG) test performed alone and with added tasks, and centre of pressure (COP) excursion in stance with several added cognitive tasks. Results: Pre intervention, depressed elders performed more poorly than controls in single and dual task balance and gait measures. Post intervention, depressed elders significantly improved in their affective state (p < 0.001), and single and dual task TUG speed (p < 0.03, range improvement 4−14s), whereas control subjects showed no change. There were fewer changes in COP excursion post intervention. Conclusions: These results suggest that dual task interference with postural control may be related to the cognitive changes occurring with improvement in depression, but that this may be dependent on the postural task performed.
P2.100 Objective evaluation of gait parameters and psychomotor retardation in Major Depression
P2.102 Gait dysfunction in Williams syndrome: is there evidence for cerebellar involvement?
S. Aybek1° , A. Berney2 , A. Salarian3 , S. Valloton2 , K. Amininan3 , F.J.G. Vingerhoets1 Lausanne, Switzerland
D.R. Hocking1° , J.L. Bradshaw1 , J. McGinley2 , N.J. Rinehart1 1 Clayton, VIC, 2 Parkville, Australia
Background and Aims: Psychomotor retardation is part of Major Depression (MD) diagnosis criteria and has been assimilated to bradykinesia, eventhough its mechanisms are unknown. We conducted a pilot study to evaluate gait parameters, bradykinesia and posture in MD patients with an ambulatory system, allowing objective measurements. Methods: Our recently validated wireless autonomous ambulatory system, containing miniature gyroscopes, data-logger, battery and flash memory, allows to record hand movements [speed, amplitude and activity (% of time with movement)], posture (% of time standing, walking, lying or sitting) and gait parameters (speed, cadence, stance, double support, stride). Four patients with DSM-IV MD (age 58±11 y) and seven healthy controls (age 62±10 y) were asked to carry on with their usual activities while being recorded for 6 hours continuously. Results: Hands activity was significantly lower in MD (MD: 40%, controls: 60%; p < 0.05). Speed (p = 0.13) and amplitude (p = 0.71) of hand movements were similar to controls. MD patients had a trend to spend more time lying or sitting than controls (p = 0.06) but did not differ in terms of gait parameters. Conclusion: Using our newly validated ambulatory long-term monitoring system, we found that patients with MD displayed less hand movements than controls and tended to spend more time lying or sitting over 6 hours, but did not differ in terms of speed and amplitude of movement, nor in gait parameters. This suggests that psychomotor retardation described in MD might be the expression of paucity of movement rather than bradykinesia as in parkinsonism and might involved different (non-dopaminergic) mechanisms.
P2.101 Gait and dual tasking dysfunction improves with ECT or antidepressants in depressed elders S. Clewett° , S.G. Brauer, A. Broome Brisbane, Australia Background and Aims: Cognitive resources are required for gait and standing balance, with a reduction in dual task performance during these postural tasks demonstrated in previous studies of older adults with
Williams syndrome (WS) is a rare genetically-based neurodevelopmental disorder characterised by delayed development, intellectual disability and a distinctive cognitive profile. Relative to the cognitive characteristics of WS, there is a dearth of research into the movement problems in this disorder. The few clinical reports of motor problems in WS have described neurologic signs of cerebellar dysfunction such as poor balance during cerebellar sensitization tasks. However, the precise loci for the motor impairments seen in WS are as yet unclear. This study is the first to examine spatiotemporal gait characteristics in WS, the purpose of which was to examine the impact of externally imposed demands (walking speed) on gait functioning. The GAITRite walkway was used to analyse gait patterns and gait variability in children and adults with WS and healthy age- and gender-matched controls. The results were consistent with the findings from patients with cerebellar ataxia. The WS group showed reduced stride length and speed, wide base of support, a compromised ability to walk in a straight line, and higher stepto-step variability in stride and speed when compared to matched controls. However, the gait characteristics of basal ganglia impairment may overlap with cerebellar dysfunction in WS, since the reduced speed and stride length and increased stride length variability without disturbances to rhythmic timing (cadence) observed in the WS group is consistent with Parkinsonian gait. An explanation for these findings is provided which suggests that motor problems in WS might reflect abnormal neural connectivity between these two networks.
P2.103 Differential diagnosis of pseudodementia in primary care settings K. Kosma1° , A. Sianni1 , A. Ganotopoulou2 , N. Karagianni1 Greece
1 Athens, 2 Volos,
Introduction: A proportion of elderly patients suffering of depression may present symptoms of cognitive deterioration that can difficult be differentiated from true dementia. These subjects often show poor performance in commonly used screening tests for dementia which comes in contrast to their usual normal level of functioning. This condition is named