Fulvio Lauretani1,2, Laura Galuppo3, Cosimo Costantino3, Andrea Ticinesi4, Gianpaolo Ceda5,6,4, Livio Ruffini7, Anna Nardelli5, Marcello Maggio5,6,4. 1. Geriatric Unit, Geriatric Rehabilitation Department, University Hospital of Parma, Via Gramsci 14, 43100, Parma, Italy. flauretani@ao.pr.it. 2. Learning Center for Health Systems and Health Services Organization, University of Parma, Parma, Italy. flauretani@ao.pr.it. 3. Rehabilitation Medicine, Department of Clinical and Experimental Medicine, Parma University Hospital, Parma, Italy. 4. Section of Geriatrics, Department of Clinical and Experimental Medicine, University of Parma, Parma, Italy. 5. Geriatric Unit, Geriatric Rehabilitation Department, University Hospital of Parma, Via Gramsci 14, 43100, Parma, Italy. 6. Learning Center for Health Systems and Health Services Organization, University of Parma, Parma, Italy. 7. Nuclear Medicine Unit, Department of Radiology, Academic Hospital of Parma, Parma, Italy.
Abstract
BACKGROUND/ OBJECTIVE: Advanced PD is often associated with cognitive impairment and frequent falls. We describe a suggestive case report of PD associated with mild cognitive impairment (MCI) and falls. The aim of our study was to test alteration in balance potentially related to use of acetylcholinesterase inhibitor (AchEI). We address this hypothesis after keeping the patient in stable dosage of dopamine agonist. METHODS/MEASUREMENTS: We describe an initial pharmacological management in a 78-year-old man affected by Parkinson disease (PD) associated with mild cognitive impairment (MCI) and history of falls. The diagnosis of PD was also confirmed by SPECT with DATSCAN, after CT-brain exclusion of potential other causes of the symptoms. Cognitive and motor performances of the patient were initially evaluated by Mini Mental Examination State Examination (MMSE), Short Physical Performance Battery (SPPB) and Romberg test. We also recorded gait parameters using an accelerometer, while balance and stability were assessed by stabilometric platform with open and closed eyes. We repeated cognitive and motor tests and gait and balance evaluation after stable dosage of dopamine agonist before and after introduction of AchEI. RESULTS: After starting dopamine agonist therapy, there was a significant improvement in gait parameters (speed, stride/min, stride length, swing duration, and decrease in gait cycle duration and rolling duration). When stable dosage of dopamine agonist was reached, AchEI was introduced obtaining not only a significant improvement of cognitive performance, but also a significant positive change in balance. CONCLUSION AND RELEVANCE: We hypothesize that AchEI could improve stability, balance and postural instability in addition to cognitive performance in PD with MCI and balance deficits.
BACKGROUND/ OBJECTIVE: Advanced PD is often associated with cognitive impairment and frequent falls. We describe a suggestive case report of PD associated with mild cognitive impairment (MCI) and falls. The aim of our study was to test alteration in balance potentially related to use of acetylcholinesterase inhibitor (AchEI). We address this hypothesis after keeping the patient in stable dosage of dopamine agonist. METHODS/MEASUREMENTS: We describe an initial pharmacological management in a 78-year-old man affected by Parkinson disease (PD) associated with mild cognitive impairment (MCI) and history of falls. The diagnosis of PD was also confirmed by SPECT with DATSCAN, after CT-brain exclusion of potential other causes of the symptoms. Cognitive and motor performances of the patient were initially evaluated by Mini Mental Examination State Examination (MMSE), Short Physical Performance Battery (SPPB) and Romberg test. We also recorded gait parameters using an accelerometer, while balance and stability were assessed by stabilometric platform with open and closed eyes. We repeated cognitive and motor tests and gait and balance evaluation after stable dosage of dopamine agonist before and after introduction of AchEI. RESULTS: After starting dopamine agonist therapy, there was a significant improvement in gait parameters (speed, stride/min, stride length, swing duration, and decrease in gait cycle duration and rolling duration). When stable dosage of dopamine agonist was reached, AchEI was introduced obtaining not only a significant improvement of cognitive performance, but also a significant positive change in balance. CONCLUSION AND RELEVANCE: We hypothesize that AchEI could improve stability, balance and postural instability in addition to cognitive performance in PD with MCI and balance deficits.
Authors: M E Micó-Amigo; I Kingma; G S Faber; A Kunikoshi; J M T van Uem; R C van Lummel; W Maetzler; J H van Dieën Journal: Ann Biomed Eng Date: 2017-01-20 Impact factor: 3.934
Authors: Fulvio Lauretani; Yari Longobucco; Giulia Ravazzoni; Elena Gallini; Marco Salvi; Marcello Maggio Journal: Int J Environ Res Public Health Date: 2021-02-28 Impact factor: 3.390
Authors: Johanna Geritz; Julius Welzel; Clint Hansen; Corina Maetzler; Markus A Hobert; Morad Elshehabi; Alexandra Sobczak; Jennifer Kudelka; Christopher Stiel; Johanne Hieke; Annekathrin Alpes; Nico Bunzeck; Walter Maetzler Journal: Front Neurol Date: 2022-07-19 Impact factor: 4.086
Authors: Per Odin; K Ray Chaudhuri; Jens Volkmann; Angelo Antonini; Alexander Storch; Espen Dietrichs; Zvezdan Pirtošek; Tove Henriksen; Malcolm Horne; David Devos; Filip Bergquist Journal: NPJ Parkinsons Dis Date: 2018-05-10