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Tasks of Attention Augment Rigidity in Mild Parkinson Disease

Published online by Cambridge University Press:  02 December 2014

Dan A. Mendon¸a  and
Mandar S. Jog
Dan A. Mendon¸a
Affiliation:
Grand River Hospital, Kitchener Movement Disorders Program, University of Western Ontario, London, Ontario, Canada
Mandar S. Jog*
Affiliation:
Movement Disorders Program, University of Western Ontario, London, Ontario, Canada
*
Department of Clinical Neurosciences, London Health Sciences Centre – University Campus, 339 Windermere Road, P.O. Box 5339, London, Ontario, N6A 5A5, Canada.
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Abstract

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Objective:

The purpose of this study was to determine whether tasks involving effortful attention would cause augmentation of rigidity in patients with mild Parkinson disease.

Methods:

In 17 subjects with mild Parkinson disease, rigidity in a single arm was assessed during various experimental conditions by a blinded movement disorders neurologist. Rigidity was scored separately at the wrist and the elbow using an ordinal scale. In three of the conditions, sustained attention was directed toward visual, auditory or movement-related stimuli. Two varieties of Froment maneuver served as positive controls: contralateral hand opening-closing or ipsilateral foot tapping. In addition, rigidity was assessed twice with subjects resting. The examiner was unaware of the sequence of experimental conditions and this was changed for each subject. Mean rigidity scores for the various experimental conditions were compared against the baseline state (an average of both trials with the patient resting) using a repeated measures ANOVA and post-hoc Tukey-Kramer multiple comparisons test.

Results:

Rigidity was significantly increased from baseline with each of the attentional tasks (p <0.01 to p <0.001) and also with the two Froment maneuvers (p <0.001). Rigidity augmentation with contralateral hand opening-closing was significantly greater than with any of the attentional tasks (p <0.05 to p <0.001).

Conclusion:

Tasks of effortful attention did appear to augment rigidity in patients with mild Parkinson disease. We speculate that the greater augmentation seen with the Froment maneuver could have an anatomic basis.

Résumé:

RÉSUMÉ:Objectif:

Le but de cette étude était de déterminer si des tâches qui demandent une attention soutenue causent une augmentation de la rigidité chez les patients atteints d’une maladie de Parkinson légère (MPL).

Méthodes:

La rigidité dans un bras a été évaluée en aveugle par un neurologue spécialisé dans les troubles du movement chez 17 individus atteints de MPL dans différentes conditions expérimentales. La rigidité était évaluée séparément au niveau du poignet et du coude au moyen d’une échelle ordinale. Dans trois des expériences, l’attention était dirigée vers des stimuli visuels, auditifs ou en relation avec le mouvement. Deux types de manoeuvres de Froment servaient de témoin positif : ouvrir et fermer la main contra–latérale et taper du pied homolatéral. De plus, la rigidité a été évaluée deux fois au repos. L’examinateur ne connaissait pas l’ordre des conditions expérimentales qui était modifié d’un sujet à l’autre. Les scores moyens de rigidité dans les différentes conditions expérimentales ont été comparés au score de base (la moyenne des deux essais effectués chez le sujet au repos) au moyen de l’ANOVA pour les mesures répétées et du test de comparaisons multiples a posteriori de Tukey–Kramer.

Résultats:

La rigidité était augmentée de façon significative par rapport aux conditions de base lorsque les sujets effectuaient des tâches demandant de l’attention (p < 0,01 à p < 0,001) et lors des deux manoeuvres de Froment (p < 0,001). Lorsque le sujet ouvrait et fermait la main opposée (p < 0,05 à p < 0,001), la rigidité augmentait beaucoup plus que lors des tâches nécessitant de l’attention

Conclusion:

Les tâches qui nécessitent une attention soutenue semblent augmenter la rigidité chez les patients atteints deMPL. Nous croyons que l’augmentation plus marquée observée lors de la manoeuvre de Froment pourrait avoir un fondement anatomique.

Type
Original Articles
Information
Canadian Journal of Neurological Sciences , Volume 35 , Issue 4 , September 2008 , pp. 501 - 505
Copyright
Copyright © The Canadian Journal of Neurological 2008

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