Acoustic characteristics of Italian Parkinsonian speech: a study on early-stage patients

Parkinson’s Disease (PD) is a neurological illness which also has effects on speech production, resulting in segmental and suprasegmental abnormalities. The aim of the current study is to test the validity of two acoustic parameters - %V and VtoV - for the detection of rhythmical variation in early-stage PD speech, in comparison to healthy speech. 40 Italian native speakers were enrolled in the research, 20 early-stage PD subjects and 20 neurologically healthy and matched controls, and a corpus of read speech was collected. The results of voice analysis confirmed an alteration of vocalic duration and %V in PD productions. In particular, %V could be a reliable cue for PD speech characterization, even at the very early onset of the disease

Molecular imaging markers to track Huntington’s disease pathology

Huntington’s disease (HD) is a progressive, monogenic dominant neurodegenerative disorder caused by repeat expansion mutation in the huntingtin gene. The accumulation of mutant huntingtin protein, forming intranuclear inclusions, subsequently leads to degeneration of medium spiny neurons in the striatum and cortical areas. Genetic testing can identify HD gene carriers before individuals develop overt cognitive, psychiatric, and chorea symptoms. Thus, HD gene carriers can be studied in premanifest stages to understand and track the evolution of HD pathology. While advances have been made, the precise pathophysiological mechanisms underlying HD are unclear. Magnetic resonance imaging (MRI) and positron emission tomography (PET) have been employed to understand HD pathology in presymptomatic and symptomatic disease stages. PET imaging uses radioactive tracers to detect specific changes, at a molecular level, which could be used as markers of HD progression and to monitor response to therapeutic treatments for HD gene expansion carriers (HDGECs). This review focuses on available PET techniques, employed in cross-sectional and longitudinal human studies, as biomarkers for HD, and highlights future potential PET targets. PET studies have assessed changes in postsynaptic dopaminergic receptors, brain metabolism, microglial activation, and recently phosphodiesterase 10A (PDE10A) as markers to track HD progression. Alterations in PDE10A expression are the earliest biochemical change identified in HD gene carriers up to 43 years before predicted symptomatic onset. Thus, PDE10A expression could be a promising marker to track HD progression from early premanifest disease stages. Other PET targets which have been less well investigated as biomarkers include cannabinoid, adenosine, and GABA receptors. Future longitudinal studies are required to fully validate these PET biomarkers for use to track disease progression from far-onset premanifest to manifest HD stages. PET imaging is a crucial neuroimaging tool, with the potential to detect early changes and validate sensitivity of biomarkers for tracking HD pathology. Moreover, continued development of novel PET tracers provides exciting opportunities to investigate new molecular targets, such as histamine and serotonin receptors, to further understand the mechanisms underlying HD pathology

The hunger strike in prison: bioethical and medico-legal insights arising from a recent opinion of the Italian national bioethics committee

: This contribution addresses some bioethical and medico-legal issues of the opinion formulated by the Italian National Bioethics Committee (CNB) in response to the dilemma between the State's duty to protect the life and health of the prisoner entrusted to its care and the prisoner's right to exercise his freedom of expression. The prisoner hunger strike is a form of protest frequently encountered in prison and it is a form of communication but also a language used by the prisoner in order to provoke changes in the prison condition. There are no rules in the prison regulations, nor in the laws governing the legal status of prisoners, that allow the conscious will of the capable and informed subject to be opposed and forced nutrition to be carried out. However, this can in no manner make therapeutic abandonment legitimate: the medical doctor should promote every action to support the patient. In the recent opinion formulated by the CNB it was remarked how self-determination is a central concept in human rights and refers to an individual's ability to make autonomous and free decisions about his or her life and body

Speech Rhythm Variation in Early-Stage Parkinson's Disease: A Study on Different Speaking Tasks

Patients with Parkinson's disease (PD) usually reveal speech disorders and, among other symptoms, the alteration of speech rhythm. The purpose of this study is twofold: (1) to test the validity of two acoustic parameters—%V, vowel percentage and VtoV, the mean interval between two consecutive vowel onset points—for the identification of rhythm variation in early-stage PD speech and (2) to analyze the effect of PD on speech rhythm in two different speaking tasks: reading passage and monolog. A group of 20 patients with early-stage PD was involved in this study and compared with 20 age- and sex-matched healthy controls (HCs). The results of the acoustic analysis confirmed that %V is a useful cue for early-stage PD speech characterization, having significantly higher values in the production of patients with PD than the values in HC speech. A simple speaking task, such as the reading task, was found to be more effective than spontaneous speech in the detection of rhythmic variations

Impulse Control Behaviors in Parkinson's Disease: Drugs or Disease? Contribution From Imaging Studies

Impulse control behaviors (ICB) are recognized as non-motor complications of dopaminergic medications in patients with Parkinson's disease (PD). Compelling evidence suggests that ICB are not merely due to the PD-related pathology itself. Several risk factors have been identified, either demographic, clinical, genetic or neuropsychological. Neuroimaging studies have yielded controversial results regarding ICB correlates in PD and still it is not clear whether they can be triggered by the PD biology or the dopaminergic treatment stimulation. We provided an overview of the imaging studies that offered the most relevant insights into the debate about the role of drugs and disease in ICB pathophysiology. Understanding neural correlates and potential predisposing factors of these severe neuropsychiatric symptoms will be crucial to guide clinical practice and to foster preventive strategies

Non-motor impairments affect walking kinematics in Parkinson disease patients: A cross-sectional study

Background: In patients with Parkinson disease (PD), severe postural and gait impairments are rarely observed in early stage of disease and non-motor symptoms (NMS) are often overlooked. Objective: This observational study aimed to characterize the impact of non-motor impairments on walking kinematics in early stages PD patients, and to assess the differences of gait parameters and NMS between PD patients with and without mild cognitive impairment (MCI). Methods: Twenty-six patients with Modified Hoehn and Yahr Scale score≤2 were evaluated for NMS using Kings Parkinson's Pain Scale, Parkinson Fatigue Severity scale, Parkinson Anxiety Scale, Beck Depression Inventory and Epworth Sleepiness Scale, kinematic parameters through an inertial sensor and cognitive performance by a comprehensive neuropsychological battery. Results: Fatigue had a moderate negative correlation with step cadence, and a moderate to strong positive correlation with gait duration, Timed Up and Go (TUG) and TUG Dual Task (p < 0.01). Pain showed positive moderate correlation with gait duration (p < 0.01). Twelve patients resulted affected by MCI and reported significantly worse scores in gait duration, pain and fatigue (p < 0.05). According to cognitive z scores, PD-MCI group showed a moderate negative correlation between visuospatial abilities and fatigue (p < 0.05). Conclusions: NMS significantly affect walking kinematics whereas a limited role of cognitive status on motor performance occur in the early PD stages

Brain Networks and Cognitive Impairment in Parkinson's Disease

: Aim: The aim of the present study is to investigate the relationship between both functional connectivity and brain networks with cognitive decline, in patients with Parkinson's disease (PD). Introduction: PD phenotype is not limited to motor impairment but, rather, a wide range of non-motor disturbances can occur, with cognitive impairment being one of the most common. However, how the large-scale organization of brain activity differs in cognitively impaired patients, as opposed to cognitively preserved ones, remains poorly understood. Methods: Starting from source-reconstructed resting-state magnetoencephalography data, we applied the phase linearity measurement (PLM) to estimate functional connectivity, globally and between brain areas, in PD patients with and without cognitive impairment (respectively PD-CI and PD-NC), as compared with healthy subjects (HS). Further, using graph analysis, we characterized the alterations in brain network topology and related these, as well as the functional connectivity, to cognitive performance. Results: We found reduced global and nodal PLM in several temporal (fusiform gyrus, Heschl's gyrus, and inferior temporal gyrus), parietal (postcentral gyrus), and occipital (lingual gyrus) areas within the left hemisphere, in the gamma band, in PD-CI patients, as compared with PD-NC and HS. With regard to the global topological features, PD-CI patients, as compared with HS and PD-NC patients, showed differences in multi-frequencies bands (delta, alpha, gamma) in the Leaf fraction, Tree hierarchy (Th) (both higher in PD-CI), and Diameter (lower in PD-CI). Finally, we found statistically significant correlations between the Montreal Cognitive Assessment test and both the Diameter in delta band and the Th in the alpha band. Conclusion: Our work points to specific large-scale rearrangements that occur selectively in cognitively compromised PD patients and are correlated to cognitive impairment. Impact statement In this article, we want to test the hypothesis that the cognitive decline observed in Parkinson's disease (PD) patients may be related to specific changes of both functional connectivity and brain network topology. Specifically, starting from magnetoencephalography signals and by applying the phase linearity measurement (PLM), a connectivity metric that measures the synchronization between brain regions, we were able to highlight differences in the global and nodal PLM values in PD patients with cognitive impairment as compared with both cognitively unimpaired patients and healthy subjects. Further, using graph analysis, we analyzed alterations in brain network topology that were related to cognitive functioning

Alternativas de desarrollo rural y formas de organización social. Fase IV: El campo del desarrollo rural y los conflictos por la tierra en la frontera agraria de Misiones. 16H161

Se apunta a producir conocimientos básicos sobre las condiciones de reproducción de los pequeños productores familiares en la frontera agraria de Misiones, una de las áreas de mayor pobreza de la Argentina. El objetivo general es analizar el campo del desarrollo rural y los conflictos actuales por la tenencia de la tierra en la etapa de cierre de la frontera agraria, identificando los actores intervinientes (agencias estatales, ONGs, pequeños productores y terratenientes) y los ejes que lo estructuran. Se estudiarán los procesos actuales de ocupación de tierras fiscales y privadas y las diversas formas de explotación, especialmente con relación a la creación de reservas ambientales (corredor verde, y biosfera Yabotí). Se describirá la dinámica de la explotación familiar en conexión con sus prácticas reproductivas y los modos en que se expresan las obligaciones domésticas en el contexto actual de restricción del acceso a la tierra. Se analizarán los estilos de intervención, las tecnologías intelectuales y los modos de comunicación de las diferentes agencias de desarrollo —estatales y nogubernamentales— y de los grupos ecologistas, así como la capacidad de agencia de los pequeños agricultores, atendiendo a sus acciones organizativas (asociaciones, ferias francas, grupos de crédito, etc.)

Correlates of the discrepancy between objective and subjective cognitive functioning in non-demented patients with Parkinson’s disease

Abstract: Background: Subjective complaints of cognitive deficits are not necessarily consistent with objective evidence of cognitive impairment in Parkinson’s disease (PD). Here we examined the factors associated with the objective-subjective cognitive discrepancy. Methods: We consecutively enrolled 90 non-demented patients with PD who completed the Parkinson’s Disease Cognitive Functional Rating Scale (subjective cognitive measure) and the Montreal Cognitive Assessment (MoCA; objective cognitive measure). The patients were classified as “Overestimators”, “Accurate estimators”, and “Underestimators” on the basis of the discrepancy between the objective vs. subjective cognitive measures. To identify the factors distinguishing these groups from each other, we used chi-square tests or one-way analyses of variance, completed by logistic and linear regression analyses. Results: Forty-nine patients (54.45%) were classified as “Accurate estimators”, 29 (32.22%) as “Underestimators”, and 12 (13.33%) as “Overestimators”. Relative to the other groups, the “Underestimators” scored higher on the Fatigue Severity Scale (FSS), Beck Depression Inventory (BDI), and Parkinson Anxiety Scale (p < 0.01). Logistic regression confirmed that FSS and BDI scores distinguished the “Underestimators” group from the others (p < 0.05). Linear regression analyses also indicated that FSS and BDI scores positively related to objective-subjective cognitive discrepancy (p < 0.01). “Overestimators” scored lower than other groups on the MoCA’s total score and attention and working memory subscores (p < 0.01). Conclusion: In more than 45% of consecutive non-demented patients with PD, we found a ‘mismatch’ between objective and subjective measures of cognitive functioning. Such discrepancy, which was related to the presence of fatigue and depressive symptoms and frontal executive impairments, should be carefully evaluated in clinical setting