Involvement of specific executive functions in mobility in Parkinson's disease

Contains fulltext : 116553.pdf (publisher's version ) (Open Access)Postural instability and gait disorders (PIGD) in Parkinson's disease (PD) seem to be associated with executive dysfunction. We investigated which specific executive functions are associated with functional mobility in mildly affected PD patients. Functional mobility (Timed Up&Go Test, TUG), PIGD score, (spatial) working memory, set shifting, response inhibition and response generation were assessed in a large cohort of 232 non-demented PD patients. Both performance on the TUG and PIGD score were weakly associated with working memory and response generation (semantic and phonemic fluency). TUG also correlated with semantic fluency when corrected for disease severity and age. These results indicate that response generation and working memory are associated with (and possibly also causally related to) gait and balance deficits. In order to fully interpret gait and postural stability of PD patients in everyday situations, the role of impairments in working memory and response generation should be taken into account.3 p

Cerebral small vessel disease and incident parkinsonism: The RUN DMC study

Objective: To investigate the relation between baseline cerebral small vessel disease (SVD) and the risk of incident parkinsonism using different MRI and diffusion tensor imaging (DTI) measures. Methods: In the Radboud University Nijmegen Diffusion Tensor and Magnetic Resonance Cohort (RUN DMC) study, a prospective cohort study, 503 elderly participants with SVD and without parkinsonism were included in 2006. During follow-up (2011-2012), parkinsonism was diagnosed according to UK Brain Bank criteria. Cox regression analysis was used to investigate the association between baseline imaging measures and incident all-cause parkinsonism and vascular parkinsonism (VP). Tract-based spatial statistics analysis was used to identify differences in baseline DTI measures of white matter (WM) tracts between participants with VP and without parkinsonism. Results: Follow-up was available from 501 participants (mean age 65.6 years; mean follow-up duration 5.2 years). Parkinsonism developed in 20 participants; 15 were diagnosed with VP. The 5-year risk of (any) parkinsonism was increased for those with a high white matter hyperintensity (WMH) volume (hazard ratio [HR] 1.8 per SD increase, 95% confidence interval [CI] 1.3-2.4) and a high number of lacunes (HR 1.4 per number increase, 95% CI 1.1-1.8) at baseline. For VP, this risk was also increased by the presence of microbleeds (HR 5.7, 95% CI 1.9-16.8) and a low gray matter volume (HR 0.4 per SD increase, 95% CI 0.2-0.8). Lower fractional anisotropy values in bifrontal WM tracts involved in movement control were observed in participants with VP compared to participants without parkinsonism. Conclusions: SVD at baseline, especially a high WMH volume and a high number of lacunes, is associated with incident parkinsonism. Our findings favor a role of SVD in the etiology of parkinsonism