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P1.148 Effect of Parkinson's disease on adaptation-learning in a 3D virtual reality environment
Poster presentations / Parkinsonism and Related Disorders 15S2 (2009) S29–S199
HY staging, and motor manifestations and complications between men and women. NMSS total score was 54.01±41.39 for men and 60.76±46.34 for women (p = 0.09). Sleep/fatigue, Mood/apathy, and Miscellaneous domains showed significantly higher scores for women (p = 0.03–0.005), whereas men showed higher scores for Sexual function domain (p < 0.0001). Regarding NMSS items, women had significant more problems than men with falls because of fainting, more difficulties falling or staying asleep, more anxiousness, and anhedonia (p = 0.001–0.006). On the contrary, men showed more troubles with drooling (p = 0.008) and problems having sex (p < 0.0001). Conclusions: Some NMSS domains and items showed significant differences by gender. These findings suggest different NMS profiles for men and women and must be taken into account in clinical settings. P1.148 Effect of Parkinson’s disease on adaptation-learning in a 3D virtual reality environment D. Mongeon1 , P.J. Blanchet2 , S. Bergeron1 , J. Messier1,3 . 1 Kin´esiologie, 2 Stomatologie, Universit´e de Montr´eal, 3 Institut Universitaire de G´eriatrie de Montr´eal, Montr´eal, QC, Canada Evidence suggests disorders in adaptation learning in Parkinson’s disease (PD). This ability is critical for normal motor function and for successful adaptation to novel situations. The exact nature and the basis of the adaptation learning deficits in PD are poorly understood and hotly debated. We used an integrated 3D virtual reality environment and motion analysis system to create novel visuomotor situations and measure movement abnormalities to examine whether PD patients are more impaired in implicit visuomotor learning or in their ability to use explicit knowledge to adapt movements. We manipulated de size of spatial errors made during adaptation by varying the temporal evolution of the perturbation across trials. In the explicit task, the 3D visuomotor perturbation was applied suddenly (at full scale starting from trial 1), whereas in the implicit task, the perturbation was applied gradually (increasing in small undetectable steps over many trials). Preliminary findings in 4 PD patients (OFF medication) and 4 agematched healthy controls indicate that PD patients are impaired in visuomotor learning when the task involve the conscious detection of large spatial errors and the utilization of explicit corrective strategies to accurately reach to the appropriate spatial location. In contrast, in the early stages of the implicit version of our visuomotor task, when visual perturbations are undetectable and spatial errors are small, PD patients tested showed normal movement adaptation skills. If this finding is confirmed in a larger group of patients, this would have major implications for our understanding of motor adaptation mechanisms in PD. P1.149 The ICF to classify activity and participation in Parkinson’s disease R. Nickel1 , A. Fedeger1 , H. Teive2 , R. Munhoz2 , L. Pinto1 , A. Lima1 . 1 Occupational Therapy Course, 2 Movement Disorders Ambulatory – Clinical Hospital, Federal University of Parana, Curitiba, Brazil The World Health Organization (WHO) recommends the ICF (International Classification of Functioning, Disability and Health) as an current reference to classify and identify aspects that goes beyond the health condition, and may they are intervening in people’s functionality to accomplish activities. In this transversal study the occupational performance of 46 citizens diagnosed with Parkinson Diseases (PD) was evaluated through the Canadian Occupational Performance Measure (COPM) and the difficulties related were codified in to five ICF domains. The observed variable had not presented statistics relevance; however the community, social and civic life was the ICF domain had brought the greater amount of patient’s complaints. The analysis between the five ICF
S67
domains and others the rigidity was the variable that presented an average correlation of “r −0.452” (p < 0.01). The results evidence the importance of promotion and maintenance a community, social and civic life for citizens with DP also the rigidity main complain as an important component related to the occupational performance. The COPM in set with the Health Model proposed in ICF by WHO revealed effective, especially when the activity is the focus of the evaluation. It permits to correlate functions and structures of the body, environment and personal aspects with the performance’s difficulties to accomplish meaningful activities. P1.150 Body mass index, abdominal circumference and the risk of falls in Parkinson’s disease R.P. Munhoz1 , H. Teive2 , L. Filla1 , M. Moscovich1 , H. Fameli1 . 1 Neurology Department, Pontifical University of Parana, 2 Neurology Department, Clinical Hospital, Curitiba, Brazil Objective: To analyze the influence of body mass index (BMI) and abdominal circumference (AC) in the risk of falls in patients with Parkinson’s disease (PD). Background: Increased BMI and AC are known risk factors for vascular disorders. Subcortical white matter lesions of vascular origin are associated with worse measurements of postural instability and falls in the elderly. We hypothesized that PD patients with increased BMI and AC may be at increased risk of falls. Methods: We assessed consecutive PD patients. Risk of falls was determined the specific UPDRS part II item. BMI above 25 kg/m2 and AC above 88 cm for women and 102 cm for men were considered elevated. Results: From a total of 76 patients included in the study, 42 (55.2%) were female, mean age was 71.2 years, mean disease duration 8.3 years. Mean BMI was 25.9 kg/m2 and mean AC was 94.8 cm for men and 94.1 cm for women. Positive history of falls was detected in 43 (56.6%) patients. BMI > 25 kg/m2 was found in 44 (57.9%) cases. Among those with increased BMI, falls were reported by 19 (43.2%) while in the group with normal BMI, only 6 (18.7%). Difference was statistically significant (p: 0.046). AC were increased in 7 (20%) men and 29 (69%) women. Falls were reported in 12 and 13 for men and women respectively, p: 0.6. Conclusions: Patients with PD and BMI above 25 kg/m2 were more likely to report falls. Increased AC was not correlated with a positive history of falls. P1.151 Differential diagnoses of 1528 patients with parkinsonism followed in a tertiary movement disorders clinic R.P. Munhoz1 , H. Teive2 , L.C. Werneck2 , M. Moscovich1 , L. Filla1 . 1 Parkinson’s Association of Paran´ a, 2 Clinical Hospital, Curitiba, Brazil Objective: To investigate the etiologic diagnoses of parkinsonism, underlining aspects of each form and comparing clinical phenotypes. Methods: A large sample of patients with parkinsonism was analyzed, gathering data on demography, motor and non-motor characteristics, as well as the final etiologic diagnoses based on established criteria. Results: A total of 1528 patients were included, Parkinson’s disease (PD) was the most common diagnosis representing 74.7%, followed by drug-induced parkinsonism (DIP) in 7.9%, vascular parkinsonism in 3.9%, other neurodegenerative disorders in 10%, and rare sporadic causes, divided as genetic, infectious and others, that summed 3.5%. Comparative analysis of these groups showed that each has particularities that extend beyond their diagnostic criteria. Conclusions: The main conclusions are that the most important causes of parkinsonism in this setting are typical, with PD been the most common diagnosis, although other causes were frequent, encompassing one fourth of all cases. Although DIP was identified in a particularly large part of this sample, this proportion is smaller
HY staging, and motor manifestations and complications between men and women. NMSS total score was 54.01±41.39 for men and 60.76±46.34 for women (p = 0.09). Sleep/fatigue, Mood/apathy, and Miscellaneous domains showed significantly higher scores for women (p = 0.03–0.005), whereas men showed higher scores for Sexual function domain (p < 0.0001). Regarding NMSS items, women had significant more problems than men with falls because of fainting, more difficulties falling or staying asleep, more anxiousness, and anhedonia (p = 0.001–0.006). On the contrary, men showed more troubles with drooling (p = 0.008) and problems having sex (p < 0.0001). Conclusions: Some NMSS domains and items showed significant differences by gender. These findings suggest different NMS profiles for men and women and must be taken into account in clinical settings. P1.148 Effect of Parkinson’s disease on adaptation-learning in a 3D virtual reality environment D. Mongeon1 , P.J. Blanchet2 , S. Bergeron1 , J. Messier1,3 . 1 Kin´esiologie, 2 Stomatologie, Universit´e de Montr´eal, 3 Institut Universitaire de G´eriatrie de Montr´eal, Montr´eal, QC, Canada Evidence suggests disorders in adaptation learning in Parkinson’s disease (PD). This ability is critical for normal motor function and for successful adaptation to novel situations. The exact nature and the basis of the adaptation learning deficits in PD are poorly understood and hotly debated. We used an integrated 3D virtual reality environment and motion analysis system to create novel visuomotor situations and measure movement abnormalities to examine whether PD patients are more impaired in implicit visuomotor learning or in their ability to use explicit knowledge to adapt movements. We manipulated de size of spatial errors made during adaptation by varying the temporal evolution of the perturbation across trials. In the explicit task, the 3D visuomotor perturbation was applied suddenly (at full scale starting from trial 1), whereas in the implicit task, the perturbation was applied gradually (increasing in small undetectable steps over many trials). Preliminary findings in 4 PD patients (OFF medication) and 4 agematched healthy controls indicate that PD patients are impaired in visuomotor learning when the task involve the conscious detection of large spatial errors and the utilization of explicit corrective strategies to accurately reach to the appropriate spatial location. In contrast, in the early stages of the implicit version of our visuomotor task, when visual perturbations are undetectable and spatial errors are small, PD patients tested showed normal movement adaptation skills. If this finding is confirmed in a larger group of patients, this would have major implications for our understanding of motor adaptation mechanisms in PD. P1.149 The ICF to classify activity and participation in Parkinson’s disease R. Nickel1 , A. Fedeger1 , H. Teive2 , R. Munhoz2 , L. Pinto1 , A. Lima1 . 1 Occupational Therapy Course, 2 Movement Disorders Ambulatory – Clinical Hospital, Federal University of Parana, Curitiba, Brazil The World Health Organization (WHO) recommends the ICF (International Classification of Functioning, Disability and Health) as an current reference to classify and identify aspects that goes beyond the health condition, and may they are intervening in people’s functionality to accomplish activities. In this transversal study the occupational performance of 46 citizens diagnosed with Parkinson Diseases (PD) was evaluated through the Canadian Occupational Performance Measure (COPM) and the difficulties related were codified in to five ICF domains. The observed variable had not presented statistics relevance; however the community, social and civic life was the ICF domain had brought the greater amount of patient’s complaints. The analysis between the five ICF
S67
domains and others the rigidity was the variable that presented an average correlation of “r −0.452” (p < 0.01). The results evidence the importance of promotion and maintenance a community, social and civic life for citizens with DP also the rigidity main complain as an important component related to the occupational performance. The COPM in set with the Health Model proposed in ICF by WHO revealed effective, especially when the activity is the focus of the evaluation. It permits to correlate functions and structures of the body, environment and personal aspects with the performance’s difficulties to accomplish meaningful activities. P1.150 Body mass index, abdominal circumference and the risk of falls in Parkinson’s disease R.P. Munhoz1 , H. Teive2 , L. Filla1 , M. Moscovich1 , H. Fameli1 . 1 Neurology Department, Pontifical University of Parana, 2 Neurology Department, Clinical Hospital, Curitiba, Brazil Objective: To analyze the influence of body mass index (BMI) and abdominal circumference (AC) in the risk of falls in patients with Parkinson’s disease (PD). Background: Increased BMI and AC are known risk factors for vascular disorders. Subcortical white matter lesions of vascular origin are associated with worse measurements of postural instability and falls in the elderly. We hypothesized that PD patients with increased BMI and AC may be at increased risk of falls. Methods: We assessed consecutive PD patients. Risk of falls was determined the specific UPDRS part II item. BMI above 25 kg/m2 and AC above 88 cm for women and 102 cm for men were considered elevated. Results: From a total of 76 patients included in the study, 42 (55.2%) were female, mean age was 71.2 years, mean disease duration 8.3 years. Mean BMI was 25.9 kg/m2 and mean AC was 94.8 cm for men and 94.1 cm for women. Positive history of falls was detected in 43 (56.6%) patients. BMI > 25 kg/m2 was found in 44 (57.9%) cases. Among those with increased BMI, falls were reported by 19 (43.2%) while in the group with normal BMI, only 6 (18.7%). Difference was statistically significant (p: 0.046). AC were increased in 7 (20%) men and 29 (69%) women. Falls were reported in 12 and 13 for men and women respectively, p: 0.6. Conclusions: Patients with PD and BMI above 25 kg/m2 were more likely to report falls. Increased AC was not correlated with a positive history of falls. P1.151 Differential diagnoses of 1528 patients with parkinsonism followed in a tertiary movement disorders clinic R.P. Munhoz1 , H. Teive2 , L.C. Werneck2 , M. Moscovich1 , L. Filla1 . 1 Parkinson’s Association of Paran´ a, 2 Clinical Hospital, Curitiba, Brazil Objective: To investigate the etiologic diagnoses of parkinsonism, underlining aspects of each form and comparing clinical phenotypes. Methods: A large sample of patients with parkinsonism was analyzed, gathering data on demography, motor and non-motor characteristics, as well as the final etiologic diagnoses based on established criteria. Results: A total of 1528 patients were included, Parkinson’s disease (PD) was the most common diagnosis representing 74.7%, followed by drug-induced parkinsonism (DIP) in 7.9%, vascular parkinsonism in 3.9%, other neurodegenerative disorders in 10%, and rare sporadic causes, divided as genetic, infectious and others, that summed 3.5%. Comparative analysis of these groups showed that each has particularities that extend beyond their diagnostic criteria. Conclusions: The main conclusions are that the most important causes of parkinsonism in this setting are typical, with PD been the most common diagnosis, although other causes were frequent, encompassing one fourth of all cases. Although DIP was identified in a particularly large part of this sample, this proportion is smaller