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2334 Neural correlates of externally Versus internally guided dance-based therapies for people with Parkinson’s disease
- Amrit Kashyap, Madeleine Hackney, Venkatagiri Krishnamurthy, Lisa Krishnamurthy, Krish Sathian, Bruce Crosson, Steve Wolf, Daniel Corcos, Jonathan Drucker, Marian Evatt, Gopi Kaundinya, Aaron Bozzorg, Ariel Hart
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- Journal:
- Journal of Clinical and Translational Science / Volume 2 / Issue S1 / June 2018
- Published online by Cambridge University Press:
- 21 November 2018, p. 21
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OBJECTIVES/SPECIFIC AIMS: Parkinson’s disease (PD) is a condition that affects over a million Americans, and despite current medical therapies, the progression of the disease results in impaired generation of internally timed or guided (IG) movements. To address this loss of motor function, previous rehabilitation therapies have focused on remediating the affected striatal-thalamic-cortical circuits (STC), primarily thought to be responsible in generating timed motor patterns. However, given the disease leads to the cell death of dopaminergic cells that are essential for proper STC function, we propose a motor therapy aimed at utilizing a compensatory parallel cerebellar-thalamic-cortical (CTC) pathway, recruited to perform externally guided (EG) movements, in which gait initiation is driven from sensory input. Our previous study has shown efficacy in our novel argentine tango therapy and improves behavioral measures above the relevant MCID threshold, but it has not been established that the CTC are in the causal pathway that are responsible for these changes. Using neural measures from task fMRI, we have begun to characterize networks that have changed and quantify any associations with behavioral metrics. METHODS/STUDY POPULATION: Patients were randomly assigned to an IG (n=18), EG (n=18), or education contact control (n=14). Participants were assessed preintervention and postintervention for behavioral motor and cognitive measures and neurophysiologically with task based fMRI. In the task, participants performed a foot tapping task under both IG (tap their foot in previously learned rhythm) or EG (tap immediately after receiving a tactile cue on their hand) conditions. The fMRI data were preprocessed using AFNI and registered to MNI standard space. The brainnetome atlas was applied and the average time series of each region of interest (ROI) was used to increase the signal to noise ratio. The activation of these ROI with respect to the stimulus was modeled using GLM, and we estimated the area under the curve during the task blocks. A 1-way ANOVA analysis on these betas were performed between the pre and the post intervention time points and the ROIs that were above a significance of 0.95 were identified and corrected for multiple comparisons. The change in beta in all ROIs for each individual were calculated and then correlated with the changes in the behavioral data, to see which changes in ROI areas matched the best with the behavioral changes. RESULTS/ANTICIPATED RESULTS: The EG group showed significant changes only in the EG task in 2 areas—inferior frontal gyrus and inferior temporal sulcus. Correlating to the cognitive behavioral measures show reduced error from the Inferior frontal gyrus (corr>0.5) best reflect changes in observed. There were no changes to either the STC or the CTC pathways. The IG group showed no changes behaviorally and showed no changes neurally as well. The control group showed no changes behaviorally, but neuronally certain DMN nodes, such as the precuneus and inferior temporal regions showed a significant change for both tasks. DISCUSSION/SIGNIFICANCE OF IMPACT: Addressing the damaged STC pathway directly through IG therapy may not be effective. The EG therapy may not be able to enhance the STC pathway. However, the therapy appears to utilize new areas in the frontal regions and correlates with positively with changes in spatial memory and balance tasks. Contrary to our hypothesis the CTC circuit was not upregulated for performance of the IG or EG task, but therapy may have enhanced recruitment of other cognitively engaged areas. The educational control group interestingly showed changes in the DMN network, which has been shown to be linked to attention during tasks blocks.
Association between vitamin B12-containing supplement consumption and prevalence of biochemically defined B12 deficiency in adults in NHANES III (Third National Health and Nutrition Examination Survey)
- Marian L Evatt, Paul D Terry, Thomas R Ziegler, Godfrey P Oakley, Jr
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- Journal:
- Public Health Nutrition / Volume 13 / Issue 1 / January 2010
- Published online by Cambridge University Press:
- 11 June 2009, pp. 25-31
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Objective
To explore the association between vitamin B12 (B12)-containing supplement use, low B12 concentrations and biochemically defined B12 deficiency in US adults.
DesignA cross-sectional study with adjustment for survey design. Prevalence ratios for two age groups (18–50 and >50 years) were estimated using unconditional logistic models. Outcome measures included prevalence of low serum B12 concentration (<148 pmol/l) and biochemical B12 deficiency (serum B12 < 148 pmol/l with concomitant homocysteine > 10 μmol/l).
SettingA population survey of health and nutritional measures.
SubjectsSubjects were non-institutionalized adults, aged 18 years and older, who participated in Phase 2 of NHANES III (Third National Health and Nutrition Examination Survey).
ResultsLow B12 concentrations were less prevalent among persons consuming B12-containing supplements (P = 0·001) with an adjusted prevalence ratio of 0·6 (95 % CI 0·3, 1·0). Biochemical B12 deficiency showed a similar trend (P = 0·0002), with an adjusted prevalence ratio of 0·3 (95 % CI 0·1, 0·8). Prevalence ratios were similar in adults >50 years of age, although the prevalence of low B12 and biochemical deficiency was proportionally higher.
ConclusionsConsumption of B12-containing supplements was associated with at least 50 % lower prevalence of both low serum B12 and biochemical B12 deficiency in a nationally representative sample of US adults, suggesting increased consumption of B12 from supplements or from fortified foods may reduce the prevalence of B12 deficiency. Additionally, the current Recommended Daily Allowance for B12 of 2·4 μg may be insufficient for those aged >50 years.
33 - Parkinson's disease
- from PART III - DISORDERS OF MOTOR CONTROL
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- By Marian L. Evatt, Department of Neurology, Emory University School of Medicine, Atlanta, Georgia, GA, USA, Mahlon R. DeLong, Department of Neurology, Emory University School of Medicine, Atlanta, Georgia, GA, USA, Jerrold L. Vitek, Department of Neurology, Emory University School of Medicine, Atlanta, Georgia, GA, USA
- Edited by Arthur K. Asbury, University of Pennsylvania School of Medicine, Guy M. McKhann, The Johns Hopkins University School of Medicine, W. Ian McDonald, University College London, Peter J. Goadsby, University College London, Justin C. McArthur, The Johns Hopkins University School of Medicine
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- Book:
- Diseases of the Nervous System
- Published online:
- 05 August 2016
- Print publication:
- 11 November 2002, pp 477-489
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Summary
Clinical neuroscience
Movement disorders may be classified as hyperkinetic, characterized by excessive, involuntary movement or hypokinetic, characterized by decreased and slowed movement. First described by James Parkinson in 1817, Parkinson's disease (PD) is the archetypal hypokinetic disorder and the second most common neurodegenerative disorder after Alzheimer's disease. Though incidence and prevalence increase with age, the total estimated incidence is 20/100000 and prevalence is 150/100000 (Schapira, 1999). In the United States, approximately one million patients have PD. The estimated societal cost tops $25 billion (Scheife et al., 2000) and is expected to rise as the population ages.
Parkinsonism: classification/clinical symptoms
‘Parkinsonism’ is a term describing syndromes combining bradykinesia, tremor, muscle rigidity, gait and balance disturbances. The term ‘idiopathic PD’ traditionally referred to patients exhibiting two or more of the cardinal signs (rest tremor, rigidity and bradykinesia) who responded to levodopa replacement therapy and did not show evidence of other neurologic disease. Given the discovery of inherited dopa-responsive PD, parkinsonian syndromes with good, sustained clinical response to dopaminergic therapy are best termed ‘primary PD’ (PPD). Infection, drugs, metabolic abnormalities, or other disease states may cause symptomatic parkinsonism. ‘Parkinson-plus’ (PD-plus) or atypical parkinsonism includes such syndromes as multiple system atrophy (MSA), progressive supranuclear palsy (PSP), Lewy body disease (LBD), the tauopathies (corticobasalganglionic degeneration and frontotemporal dementias), as well as the amyloidopathies (Alzheimer's disease with parkinsonism). These conditions typically exhibit little or no response to levodopa therapy, prominent and early gait and balance disturbance, autonomic and cognitive symptoms (Table 33.1). Table 33.2 lists signs and symptoms occuring in PPD and parkinsonian syndromes. See Chapter 34 for further discussion of the atypical syndromes.
Diagnostic criteria and clinical features for primary Parkinson's disease (PPD)
Although James Parkinson published the first description of the ‘shaking palsy’ almost 200 years ago, we still have no standardized diagnostic test for PPD. Clinical criteria for PPD vary, but most movement disorders experts agree a patient must demonstrate at least two of the three cardinal signs and experience significant, long lasting (>5 years) improvement with dopaminergic therapy (Gelb et al., 1999). With these clinical criteria and experience, neurologists’ diagnostic accuracy can approach 92% (Jankovic et al., 2000).