Publications by authors named "Hiroo Terashi"

25 Publications

  • Page 1 of 1

Persistent Hemichorea as a Preceding Symptom of Cerebral Infarction due to Middle Cerebral Artery Stenosis.

Intern Med 2021 Jun 12. Epub 2021 Jun 12.

Department of Neurology, Tokyo Medical University, Japan.

We herein report an 84-year-old woman with right middle cerebral artery (MCA) stenosis who presented with persistent left hemichorea preceding cerebral infarction. She visited our hospital on day 9 after the hemichorea onset. Magnetic resonance imaging (MRI) showed no acute cerebral infarction. Magnetic resonance angiography revealed right MCA stenosis. Her hemichorea persisted for 19 days and subsequently disappeared. On day 21, she developed left hemiplegia. Repeat MRI revealed a cerebral infarction in the right putamen. MCA stenosis can present with persistent hemichorea, even in the absence of cerebral infarction. Persistent hemichorea with MCA stenosis may presage cerebral infarction.
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http://dx.doi.org/10.2169/internalmedicine.7191-21DOI Listing
June 2021

Relationship between I-FP-CIT-SPECT and motor severity in drug-naive patients with Parkinson's disease.

J Neurol Sci 2021 Jul 6;426:117476. Epub 2021 May 6.

Department of Neurology, Tokyo Medical University, 6-7-1 Nishishinjuku, Shinjuku-ku, Tokyo 160-0023, Japan.

Introduction: Although functional imaging is useful for the diagnosis and pathophysiological evaluation of Parkinson's disease (PD), little is known about the relationship between functional imaging findings and PD clinical features. The objective of this study was to determine the relationship between I-FP-CIT-SPECT findings and motor symptoms, in particular gait disturbance.

Methods: The study included 46 drug-naive patients with early-stage PD. The specific binding ratios (SBRs) in the striatum and its subregions, namely anterior/posterior putamen and caudate nucleus, were calculated in patients who underwent I-FP-CIT-SPECT. Motor symptoms were evaluated using the modified Hoehn and Yahr (HY) stage and the Unified Parkinson's Disease Rating Scale (UPDRS) part III. Gait disturbance was evaluated by the mean gait cycle duration and the mean gait acceleration amplitude measured with a wearable sensor.

Results: The mean SBRs of the striatum and anterior putamen were significantly associated with the modified HY stage and UPDRS part III score. The mean SBR of the caudate nucleus was significantly associated with the UPDRS part III score. The mean striatal SBR was also significantly associated with the mean gait cycle duration and mean gait acceleration amplitude.

Conclusion: The mean striatal SBR, as determined by I-FP-CIT-SPECT, was significantly associated with motor severity and gait severity in drug-naive patients with PD.
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http://dx.doi.org/10.1016/j.jns.2021.117476DOI Listing
July 2021

[Posterior reversible encephalopathy syndrome during intravenous immunoglobulin therapy in Guillain-Barré syndrome].

Rinsho Shinkeigaku 2021 Jan 15;61(1):12-17. Epub 2020 Dec 15.

Department of Neurology, Tokyo Medical University.

A 63-year-old woman was diagnosed with Guillain-Barré syndrome (GBS), and intravenous immunoglobulin (IVIg) therapy was initiated. On the second day of IVIg therapy, she became less alert (JCS III-200) and had hyponatremia. Brain MRI showed vasogenic edema in bilateral occipital lobes, which disappeared afterwards. Her clinical course and MRI findings were consistent with those of posterior reversible encephalopathy syndrome (PRES). As a result of considering the timing of the onset of GBS and PRES and the degree of hyponatremia and hypertension in some documented patients, the cause of PRES onset in this case is considered to be IVIg therapy itself and IVIg therapy-induced hyponatremia.
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http://dx.doi.org/10.5692/clinicalneurol.cn-001461DOI Listing
January 2021

Cerebral Infarction and Myalgia in a 75-year-old Man with Eosinophilic Granulomatosis with Polyangiitis.

Intern Med 2020 Dec 4;59(23):3089-3092. Epub 2020 Aug 4.

Department of Neurology, Tokyo Medical University, Japan.

Eosinophilic granulomatosis with polyangiitis (EGPA) is a rare condition of systemic vasculitis of small to medium-sized blood vessels. We herein report the case of a 75-year-old man who presented with hemiplegia on his right side due to cerebral infarction following myalgia and a high fever. He had no history of asthma or allergic rhinitis. He was diagnosed with EGPA based on the presence of eosinophilia, sinusitis suggested by magnetic resonance imaging, and muscle pathology. His hemiplegia improved rapidly after corticosteroid therapy. This case suggests that EGPA should be a differential diagnosis of cerebral infarction with myalgia and eosinophilia.
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http://dx.doi.org/10.2169/internalmedicine.5099-20DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7759697PMC
December 2020

Analysis of non-invasive gait recording under free-living conditions in patients with Parkinson's disease: relationship with global cognitive function and motor abnormalities.

BMC Neurol 2020 Apr 29;20(1):161. Epub 2020 Apr 29.

Department of Neurology, Tokyo Medical University, 6-7-1 Nishishinjuku, Shinjuku-ku, Tokyo, 160-0023, Japan.

Background: We investigated the gait characteristics of patients with Parkinson's disease (PD), under free-living conditions, using a wearable device, and assessed their relationships with global cognitive function and motor abnormalities.

Methods: The study subjects comprised patients with PD aged < 80 years, with a Mini-Mental State Examination (MMSE) score of ≥20, free of any motor complications. A wearable sensor with a built-in tri-axial accelerometer was waist-mounted on each patient, and continuous, 24-h records were obtained. The mean gait cycle duration and mean gait acceleration amplitude, under free-living conditions, were computed and analyzed to determine their relationship with disease duration, MMSE score, Unified Parkinson's Disease Rating Scale (UPDRS) Part III score, and postural instability and gait difficulty (PIGD) score.

Results: The study included 106 consecutive patients with PD. The mean gait cycle duration was 1.18 ± 0.12 s, which was similar to that of the normal controls. However, the mean gait acceleration amplitude of PD patients (1.83 ± 0.36 m/s) was significantly lower than that of the control (p < 0.001). In PD patients, the mean gait acceleration amplitude correlated with the MMSE (β = 0.197, p = 0.028), UPDRS Part III (β = - 0.327, p < 0.001), and PIGD (β = - 0.235, p = 0.008) scores.

Conclusions: The gait rhythm of PD patients is preserved at levels similar to those of normal subjects. However, the mean gait acceleration amplitude was significantly reduced in patients with PD. The results indicate that gait acceleration amplitude correlates with the severity of motor disorders and global cognitive function.
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http://dx.doi.org/10.1186/s12883-020-01729-wDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7189597PMC
April 2020

Assessment and Rating of Motor Cerebellar Ataxias With the Kinect v2 Depth Sensor: Extending Our Appraisal.

Front Neurol 2020 11;11:179. Epub 2020 Mar 11.

Movement Disorders Project, Tokyo Metropolitan Institute of Medical Science, Tokyo, Japan.

Current assessment of patients with cerebellar disorders is based on conventional neurological examination that is dependent on subjective judgements. Quantitative measurement of cerebellar ataxias (CAs) is essential for assessment of evidence-based treatments and the monitoring of the progress or recovery of diseases. It may provide us a useful tool to navigate future treatments for ataxia. We developed a Kinect v2. sensor system with a novel algorithm to measure and evaluate movements for two tests of Scale for the Assessment and Rating of Ataxia (SARA): the nose-finger test and gait. For the nose-finger test, we evaluated and compared accuracy, regularities and smoothness in the movements of the index finger and the proximal limbs between cerebellar patients and control subjects. For the task of walking, we evaluated and compared stability between the two groups. The precision of the system for evaluation of movements was smaller than 2 mm. For the nose-finger test, the mildly affected patients tended to show more instability than the control subjects. For a severely affected patient, our system quantified the instability of movements of the index finger using kinematic parameters, such as fluctuations and average speed. The average speed appears to be the most sensitive parameter that contrasts between patients with CAs and control subjects. Furthermore, our system also detected the adventitious movements of more proximal body parts, such as the elbow, shoulder and head. Assessment of walking was possible only in patients with mild CAs. They demonstrated large sways and compensatory wide stances. These parameters appeared to show higher accuracy than SARA. This examiner-independent device measures movements of the points of interest of SARA more accurately than eye and further provides additional information about the ataxic movements (e.g., the adventitious movements of the elbow, shoulder and head in the nose-finger test and the wide-based walking with large oscillation in the gait task), which is out of the scope of SARA. Our new system enables more accurate scoring of SARA and further provides additional information that is not currently evaluated with SARA. Therefore, it provides an easier, more accurate and more systematic description of CAs.
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http://dx.doi.org/10.3389/fneur.2020.00179DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7078683PMC
March 2020

Association of daily physical activity with cognition and mood disorders in treatment-naive patients with early-stage Parkinson's disease.

J Neural Transm (Vienna) 2019 12 30;126(12):1617-1624. Epub 2019 Sep 30.

Department of Neurology, Tokyo Medical University, 6-7-1 Nishishinjuku, Shinjuku-ku, Tokyo, 160-0023, Japan.

To determine the association of daily physical activity with cognition, mood disorders, and olfactory function in treatment-naive patients with early-stage Parkinson's disease (PD). The study subjects were 52 treatment-naive patients with early-stage PD (< 80 years). Daily physical activity was measured using a wearable sensor with a built-in triaxial accelerometer, and its association with cognition [mini-mental state examination (MMSE), clock-drawing test (CDT), frontal assessment battery (FAB), and behavioral assessment of the dysexecutive syndrome (BADS)], depressive symptoms [Beck Depression Inventory-Second Edition (BDI-II)], apathy [Starkstein Apathy Scale (AS)], and olfactory function [Odor Stick Identification Test for the Japanese (OSIT-J)] was analyzed using multiple linear regression after adjustment for age, sex, and education status. The daily physical activity (0.42 ± 0.11 m/s) of the PD group was significantly lower than that of healthy controls (p < 0.001). Moreover, the daily physical activity of the PD group was significantly associated with FAB (β = 0.337, p = 0.027) and BADS (β = 0.374, p = 0.017) scores, but not with MMSE, CDT, BDI-II, AS, and OSIT-J scores. The daily physical activity is significantly reduced in treatment-naive patients with early-stage PD, and the low activity correlates with frontal/executive function.
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http://dx.doi.org/10.1007/s00702-019-02085-xDOI Listing
December 2019

Efficacy of istradefylline for gait disorders with freezing of gait in Parkinson's disease: A single-arm, open-label, prospective, multicenter study.

Expert Opin Pharmacother 2019 Aug 28;20(11):1405-1411. Epub 2019 May 28.

h Department of Neurology , Juntendo University Shizuoka Hospital , Izunokuni , Japan.

: Gait disorders are common in Parkinson's disease patients who respond poorly to dopaminergic treatment. Blockade of adenosine A receptors is expected to improve gait disorders. Istradefylline is a first-in-class selective adenosine A receptor antagonist with benefits for motor complications associated with Parkinson's disease. : This multicenter, open-label, single-group, prospective interventional study evaluated changes in total gait-related scores of the Part II/III Movement Disorder Society-Unified Parkinson's Disease Rating Scale (MDS-UPDRS) and Freezing of Gait Questionnaire (FOG-Q) in 31 Parkinson's disease patients treated with istradefylline. Gait analysis by portable gait rhythmogram was performed. : MDS-UPDRS Part III gait-related total scores significantly decreased at Weeks 4-12 from baseline with significant improvements in gait, freezing of gait, and postural stability. Significant decreases in MDS-UPDRS Part II total scores and individual item scores at Week 12 indicated improved daily living activities. At Week 12, there were significant improvements in FOG-Q, new FOG-Q, and overall movement per 48 h measured by portable gait rhythmogram. Adverse events occurred in 7/31 patients. : Istradefylline improved gait disorders in Parkinson's disease patients complicated with freezing of gait, improving their quality of life. No unexpected adverse drug reactions were identified. : UMIN-CTR (UMIN000020288).
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http://dx.doi.org/10.1080/14656566.2019.1614167DOI Listing
August 2019

Characteristics of apathy in treatment-naïve patients with Parkinson's disease.

Int J Neurosci 2019 Jan 29;129(1):16-21. Epub 2018 Nov 29.

a Department of Neurology , Tokyo Medical University , Shinjuku-ku , Tokyo , Japan.

Introduction: Although apathy is a common psychiatric symptom of Parkinson's disease (PD), there are many unknown aspects of its pathology. This study aimed to investigate the characteristics of apathy in treatment-naïve patients with early-stage PD.

Methods: Fifty treatment-naïve patients with early-stage PD were divided into 1 of 2 groups-apathetic or non-apathetic-based on Starkstein Apathy Scale (AS) scores. Cognitive function, depressive symptoms, olfactory function, and motor severity were compared between the two groups using validated assessment scales. Multiple linear regression was performed to assess the association between AS scores and clinical parameters.

Results: Apathy (AS score ≥16) was observed in 13 (26%) patients. Assessment scale scores (Beck Depression Inventory-Second Edition [p < .004]; modified Hoehn & Yahr stage [p = .039]; Unified Parkinson's Disease Rating Scale part III [p < .001]) were significantly higher in apathetic patients than in non-apathetic patients. Significant association between these scale scores and AS score was also evident (all p ≤ .001). There were no significant differences in the test scores derived from several other validated scales.

Conclusion: Apathy was observed in 26% of treatment-naïve patients with early-stage PD. Significant association between apathy and motor severity was found, suggesting that dysfunction of the dopaminergic pathway is involved in the pathology of apathy.
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http://dx.doi.org/10.1080/00207454.2018.1503184DOI Listing
January 2019

[A case of meningeal carcinomatosis mimicking subarachnoid hemorrhage on MRI].

Rinsho Shinkeigaku 2018 Jun 1;58(6):403-406. Epub 2018 Jun 1.

Department of Neurology, Tokyo Medical University.

We report a case of meningeal carcinomatosis that needed to be distinguished from subarachnoid hemorrhage. A 67-year-old female with acute severe headache was admitted to a previous hospital. Since high intensity signal was detected within the parietal cerebral sulci on the right side on brain FLAIR MRI, cerebral angiography was performed due to suspicion of subarachnoid hemorrhage. However, no vascular abnormality was observed. Then, cerebral spinal fluid was collected, which showed an increase in cell count, suggesting meningitis. She was transferred to our hospital for evaluation of neurological disease. After admission to our hospital, there was an episode of hematemesis. Upper gastrointestinal endoscopy was performed, and advanced gastric cancer was found. She was diagnosed as having meningeal carcinomatosis due to gastric cancer. Meningeal carcinomatosis should be considered in addition to subarachnoid hemorrhage when a patient with acute headache shows high intensity signal within the cerebral sulci on brain FLAIR MRI.
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http://dx.doi.org/10.5692/clinicalneurol.cn-001151DOI Listing
June 2018

[Cerebellar Ataxia and Autoantibodies].

Brain Nerve 2018 Apr;70(4):371-382

Tokyo Medical University Hachioji Medical Center, Department of Neurology, Tokyo Medical University Hachioji Medical Center.

The cerebellum is one of the main targets in the central nervous system for autoimmunity. Immune-mediated cerebellar ataxias include gluten ataxia, GAD antibody-associated cerebellar ataxia, Hashimoto's encephalopathy, and paraneoplastic cerebellar degeneration. Autoimmune cerebellar ataxia may be of either insidious or subacute onset, and vertigo or transient neurological symptoms occur in some patients before the onset of the disease, in contrast to spinocerebellar degeneration. If autoimmune cerebellar ataxia is suspected, early diagnosis and introduction of treatment are very important. For diagnosis, testing for gliadin antibody, TG6 antibody, GAD antibody, thyroid antibody, and anti-neuronal antibodies, including mGluR1, is useful. Magnetic resonance imaging voxel-based morphometry is also useful because it can detect cortical cerebellar atrophy of autoimmune cerebellar ataxia, different from spinocerebellar ataxia. As for treatment, it is important to remove autoimmune triggering factors (e.g.,dietary gluten or neoplasm). When the ataxia symptoms are causing hindrances in the daily life, it is worth considering immunotherapy including IVIg, steroid therapy and so on.
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http://dx.doi.org/10.11477/mf.1416201010DOI Listing
April 2018

Secondary parkinsonism.

Nihon Rinsho 2017 Jan;75(1):63-70

Although many disorders are included in secondary parkinsonism, the mechanisms underlying parkinsonism vary and have yet to be elucidated. Herein, we introduced a group of diseases included among the forms of secondary parkinsonism and provide overviews of clinically significant drug-induced parkinsonism (DIP), vascular parkinson- ism (VP), and idiopathic normal pressure hydrocephalus (iNPH) with a focus on pathophysiology and symptoms. Although DIP has the highest frequency among the forms of secondary parkinsonism, it is overlooked in many patients due to lack of knowledge about drugs by the prescribing physicians. Both VP and iNPH present with "lower body parkinsonism, " showing the characteristic gait disturbance. DIP and iNPH are treatable, highlighting the importance of early diagnosis and treatment intervention.
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January 2017

Anhedonia and its correlation with clinical aspects in Parkinson's disease.

J Neurol Sci 2017 Jan 3;372:403-407. Epub 2016 Nov 3.

Department of Neurology, Juntendo University School of Medicine, Tokyo, Japan.

Anhedonia is one of the non-motor symptoms observed in the Parkinson's disease (PD). However, there is no clear relationship between anhedonia and its correlation with other symptoms of PD. The aim of this study is to evaluate the characteristics of anhedonia and its correlation with clinical aspects of PD in a relatively large cohort. We enrolled 318 patients with PD and 62 control subjects for this study. Patients and subjects were tested using the Snaith-Hamilton Pleasure Scale Japanese version and the Beck Depression Inventory 2nd edition for the assessment of anhedonia and depression. We also investigated the correlation among clinical aspects of PD, anhedonia, and depression in patients with PD. The Snaith-Hamilton Pleasure Scale Japanese version and the Beck Depression Inventory 2nd edition scores were significantly higher in patients with PD than in control subjects (p=0.03 and p=0.0006, respectively). All PD patients with anhedonia had a significantly higher score on the unified Parkinson's disease rating scale (UPDRS) parts I and II compared to PD patients without anhedonia. Additionally, all PD patients with depression scored significantly higher on UPDRS part I-IV than PD patients without depression. The patients with anhedonia and without depression had mild motor severity and their treatment was relatively low dosage. These results suggest that anhedonia and depression are slightly linked, but not the same. PD patients with only anhedonia may be closely linked apathy found in untreated early stages of PD.
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http://dx.doi.org/10.1016/j.jns.2016.10.051DOI Listing
January 2017

A Japanese multicenter survey characterizing pain in Parkinson's disease.

J Neurol Sci 2016 Jun 14;365:162-6. Epub 2016 Apr 14.

Department of Neurological Science, Graduate School of Medicine, Nippon Medical School, 1-1-5 Sendagi, Bunkyo-ku, Tokyo 113-8603, Japan. Electronic address:

Background: Pain is a frequent, troublesome symptom of PD but is under-recognized and poorly understood.

Aim: We characterized pain prevalence, severity, and location in PD, to better understand its pathophysiology and improve diagnosis and treatment.

Subjects And Methods: A cross-sectional controlled study was conducted at 19 centers across Japan. A total of 632 subjects with Mini-Mental State Examination scores ≥24 were enrolled, including 324 PD patients and 308 controls. Sex and mean age did not differ between the two groups. Demographic and clinical data were collected. Pain was assessed using questionnaires, the SF-36v2 bodily pain scale, and a body illustration for patients to indicate the location of pain in 45 anatomical areas.

Results: Pain prevalence in the PD group was 78.6%, significantly higher than in controls (49.0%), as was its severity. There was no correlation between SF-36v2 score and motor scores, such as Unified Parkinson's Disease Rating Scale III or Hoehn & Yahr scores. Pain distribution was similar between groups, predominantly in the lower back, followed by the gluteal region, lower legs, thighs, posterior neck, and shoulders.

Conclusion: Pain is a significant problem in the Japanese PD population and we discuss its pathophysiology.
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http://dx.doi.org/10.1016/j.jns.2016.04.015DOI Listing
June 2016

Ambulatory Gait Behavior in Patients With Dementia: A Comparison With Parkinson's Disease.

IEEE Trans Neural Syst Rehabil Eng 2016 08 11;24(8):817-26. Epub 2015 Sep 11.

Accelerometry-based gait analysis is a promising approach in obtaining insightful information on the gait characteristics of patients with neurological disorders such as dementia and Parkinson's disease (PD). In order to improve its practical use outside the laboratory or hospital, it is required to design new metrics capable of quantifying ambulatory gait and their extraction procedures from long-term acceleration data. This paper presents a gait analysis method developed for such a purpose. Our system is based on a single trunk-mounted accelerometer and analytical algorithm for the assessment of gait behavior that may be context dependent. The algorithm consists of the detection of gait peaks from acceleration data and the analysis of multimodal patterns in the relationship between gait cycle and vertical gait acceleration. A set of six new measures can be obtained by applying the algorithm to a 24-h motion signal. To examine the performance and utility of our method, we recorded acceleration data from 13 healthy, 26 PD, and 26 mild cognitive impairment or dementia subjects. Each patient group was further classified into two, comprising 13 members each, according to the severity of the disease, and the gait behavior of the five groups was compared. We found that the normal, PD, and MCI/dementia groups show characteristic walking patterns which can be distinguished from one another by the developed gait measure set. We also examined conventional parameters such as gait acceleration, gait cycle, and gait variability, but failed to reproduce the distinct differences among the five groups. These findings suggest that the proposed gait analysis may be useful in capturing disease-specific gait features in a community setting.
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http://dx.doi.org/10.1109/TNSRE.2015.2477856DOI Listing
August 2016

Kinematic analysis of 24-hour recording of walking pattern in patients with vascular parkinsonism.

Int J Neurosci 2015 2;125(10):733-41. Epub 2014 Dec 2.

a Department of Neurology , Tokyo Medical University , Tokyo , Japan.

Background: There is a need to define the basic characteristics of various kinematic parameters recorded during walking in patients with vascular parkinsonism (VP). The present study was designed to determine the kinematic features of walking in VP patients. For this purpose, gait acceleration and gait cycle were recorded continuously over 24-h period of daily living in VP patients, patients with Parkinson's disease (PD), and healthy subjects.

Methods: We used our newly developed 24-h monitoring device, the portable gait rhythmogram, which records gait during walking, and computes gait-induced accelerations with pattern matching algorithm. We studied nine VP patients with history of multiple lacunar infarcts (mean age ± standard deviation (SD): 72.6 ± 5.0 years, 7 men), 39 PD patients (mean age ± SD: 70.8 ± 5.8 years, 18 women), and 15 normal control subjects (mean age ± SD: 67.9 ± 4.7 years, 9 men).

Results: The "amount of overall movements per 24 h" was lower in VP and PD, compared with the control, with no significant differences between the two groups. Gait acceleration during walking was significantly lower (p < 0.01 in each case), while the gait cycle was the same in VP and PD patients compared with the control.

Conclusions: The results suggest that deficit in force production and preservation of gait rhythm are common features of walking patterns in VP and PD patients.
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http://dx.doi.org/10.3109/00207454.2014.967350DOI Listing
May 2016

Rhinorrhea in Parkinson's disease: a consecutive multicenter study in Japan.

J Neurol Sci 2014 Aug 27;343(1-2):88-90. Epub 2014 May 27.

Department of Neurology, Juntendo University School of Medicine, 3-1-3 Hongo, Bunkyo-ku, Tokyo 113-8431, Japan.

Recent reports suggest that rhinorrhea, defined as the presence of a runny nose unrelated to respiratory infections, allergies, or sinus problems, occurs more frequently among patients with Parkinson's disease (PD) than among healthy controls. We conducted a questionnaire survey in a multicenter study throughout Japan and compared the frequency of rhinorrhea between 231 PD and 187 normal control (NC) subjects. After excluding patients with rhinitis or paranasal sinusitis, a total of 159 PD and 59 NC subjects were included in our analysis. Rhinorrhea occurred more frequently in PD patients than NC subjects (33.3% vs. 11.9%; P=0.01). Among PD patients, rhinorrhea was more common in men than women (P=0.005). Rhinorrhea was not correlated with disease duration, modified Hoehn and Yahr score, disease type (akinesia rigidity vs. tremor dominant), or cardiac sympathetic function (evaluated by (123)I-metaiodobenzylguanidine uptake). To our knowledge, this is the first multicenter study on the frequency of PD-related rhinorrhea in Asian countries.
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http://dx.doi.org/10.1016/j.jns.2014.05.039DOI Listing
August 2014

Human turnover dynamics during sleep: statistical behavior and its modeling.

Phys Rev E Stat Nonlin Soft Matter Phys 2014 Mar 31;89(3):032721. Epub 2014 Mar 31.

Tokyo Medical University, Department of Medical Education, Tokyo 1600023, Japan.

Turnover is a typical intermittent body movement while asleep. Exploring its behavior may provide insights into the mechanisms and management of sleep. However, little is understood about the dynamic nature of turnover in healthy humans and how it can be modified in disease. Here we present a detailed analysis of turnover signals that are collected by accelerometry from healthy elderly subjects and age-matched patients with neurodegenerative disorders such as Parkinson's disease. In healthy subjects, the time intervals between consecutive turnover events exhibit a well-separated bimodal distribution with one mode at ⩽10 s and the other at ⩾100 s, whereas such bimodality tends to disappear in neurodegenerative patients. The discovery of bimodality and fine temporal structures (⩽10 s) is a contribution that is not revealed by conventional sleep recordings with less time resolution (≈30 s). Moreover, we estimate the scaling exponent of the interval fluctuations, which also shows a clear difference between healthy subjects and patients. We incorporate these experimental results into a computational model of human decision making. A decision is to be made at each simulation step between two choices: to keep on sleeping or to make a turnover, the selection of which is determined dynamically by comparing a pair of random numbers assigned to each choice. This decision is weighted by a single parameter that reflects the depth of sleep. The resulting simulated behavior accurately replicates many aspects of observed turnover patterns, including the appearance or disappearance of bimodality and leads to several predictions, suggesting that the depth parameter may be useful as a quantitative measure for differentiating between normal and pathological sleep. These findings have significant clinical implications and may pave the way for the development of practical sleep assessment technologies.
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http://dx.doi.org/10.1103/PhysRevE.89.032721DOI Listing
March 2014

How far do the complaints of patients with Parkinson's disease reflect motor fluctuation? Quantitative analysis using a portable gait rhythmogram.

ISRN Neurol 2012 13;2012:372030. Epub 2012 Dec 13.

Department of Neurology, Tokyo Medical University, Tokyo 160-0023, Japan.

In advanced-stage Parkinson's disease (PD), motor fluctuation is a frequent and disabling problem. Assessment of motor fluctuation depends on patient's subjective self-statement. We examined whether the subjective fluctuation matched the objective motor fluctuation defined by gait disorders. Using a new device, the portable gait rhythmogram, we recorded gait cadence and acceleration continuously over the 24-hour period in 54 patients with PD and 17 normal controls, for the quantitative evaluation of motor fluctuation. The patients were asked to estimate motor fluctuation every hour. In 44 of 54 patients, changes in the cadence were associated with simultaneous changes in acceleration. We examined the subjective fluctuation in these 44 patients who were confirmed to have motor fluctuation. Nineteen (82.7%) of 23 patients who felt no fluctuation showed distinct gait disorders. During off time, they walked with marked short or bradykinetic stepping. No matching changes were observed in either the cadence or acceleration in 11 (52.4%) of 21 patients who perceived motor fluctuation. No synchronization was noted in 30 (68.2%) of the 44 patients, between the times of subjectively assessed motor fluctuation and those of quantitative analysis of gait disorder. This discrepancy suggests that the objective continuous recording of the cadence and acceleration is necessary to understand motor fluctuation.
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http://dx.doi.org/10.5402/2012/372030DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3530791PMC
January 2013

Independent regulation of the cycle and acceleration in parkinsonian gait analyzed by a long-term daily monitoring system.

Eur Neurol 2013 7;69(3):134-41. Epub 2012 Dec 7.

Third Department of Internal Medicine, Tokyo Medical University, Tokyo, Japan.

Background: Few reports have objectively assessed gait patterns of Parkinson's disease (PD) patients in their daily lives. We investigated the mean gait cycle and mean gait acceleration using a portable gait rhythmogram (PGR).

Method: We continuously recorded PGR measurements for 24 h in 64 PD patients with the ability to independently engage in activities of daily living.

Results: There was no significant difference in the mean gait cycle between PD patients and normal controls. However, the mean gait cycle was significantly faster in PD patients in the modified Hoehn and Yahr stage 1.5 than those in stages 2.5-3.0. The mean gait acceleration in PD patients was significantly less than in normal controls, but there were no significant differences among the stage groups.

Conclusion: The results suggest that the cycle and acceleration of gait movements are controlled independently and that disturbances in these movements have different clinical courses in PD.
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http://dx.doi.org/10.1159/000345266DOI Listing
September 2013

Deficits in scaling of gait force and cycle in parkinsonian gait identified by long-term monitoring of acceleration with the portable gait rhythmogram.

ISRN Neurol 2012 16;2012:306816. Epub 2012 Oct 16.

Department of Neurology, Tokyo Medical University, Tokyo 160-0023, Japan.

To examine the range of gait acceleration and cycle in daily walking of patients with Parkinson's disease (PD), we compared the gait of 40 patients with PD and 17 normal controls by using a newly developed long-term monitoring device that extracts gait-related accelerations from overall movements-related accelerations. The range of change in gait acceleration, relative to the control, was less than 75% in 12 patients. The range of change in gait cycle was less than 75% in 8 patients. The range of changes in both parameters was less than 75% in 4 patients. The results suggest narrow changes in gait parameters in PD.
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http://dx.doi.org/10.5402/2012/306816DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3480001PMC
November 2012

Validity and reliability assessment of a Japanese version of the Snaith-Hamilton pleasure scale.

Intern Med 2012 15;51(8):865-9. Epub 2012 Apr 15.

Department of Internal Medicine, Division of Neurology, Nephrology and Rheumatology, Nippon Medical School, Japan.

Objective: Anhedonia is one of the main non-motor symptoms in Parkinson's disease (PD); it is assessed using the Snaith-Hamilton pleasure scale (SHAPS). To assess anhedonia in the Japanese population, we prepared a Japanese language version of SHAPS (SHAPS-J), and evaluated its validity and reliability in 8 neurological centers. Seventy subjects (48 patients with PD and 22 healthy subjects) were enrolled in this study.

Methods: The validity of the test was assessed by the correlation between SHAPS-J and the apathy scale, based on the fact that anhedonia is considered a symptom of apathy syndrome. Test-retest reliability and internal consistency were assessed by Cohen's kappa and Cronbach's alpha coefficients, respectively.

Results: In the evaluation of validity, the total scores obtained on SHAPS-J during the test and retest significantly correlated with scores on Item 4 in Part 1 of the unified Parkinson's disease rating scale (p<0.0008 and p<0.0036, respectively). Cohen's kappa coefficient was >0.3 on all items (p<0.0005 on all items). Cronbach's alpha coefficient was 0.90 at the baseline and 0.88 at the retest.

Conclusion: These results indicate that SHAPS-J has good validity, test-retest reliability, and internal consistency, thus establishing an available measure of anhedonia in Japanese.
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http://dx.doi.org/10.2169/internalmedicine.51.6718DOI Listing
January 2013

Regional cerebral blood flow patterns in patients with freezing of gait due to lacunar infarction: SPECT study using three-dimensional stereotactic surface projections.

Int J Neurosci 2012 Aug 20;122(8):423-30. Epub 2012 Apr 20.

Third Department of Internal Medicine, Tokyo Medical University, Shinjuku-ku, Tokyo, Japan.

Background: Although freezing of gait (FOG) is reportedly caused by cerebrovascular disease, few studies have examined its pathology. We examined regional cerebral blood flow (rCBF) patterns in patients with FOG resulting from chronic lacunar infarction using single-photon emission computed tomography (SPECT).

Methods: Among patients with chronic lacunar infarction treated at our outpatient unit, we performed N-isopropyl-p-[(123)I]-iodoamphetamine SPECT in seven patients with FOG (FOG group) and in 20 patients without FOG (non-FOG group). We analyzed and compared the SPECT data using three-dimensional stereotactic surface projections of the two groups.

Results: On z-score maps, the FOG group showed a significant reduction in rCBF in the bilateral anterior cingulate cortices compared with the non-FOG group. The mean z-score for the bilateral cingulate gyri was significantly higher in the FOG group than in the non-FOG group (p < .01). When the cingulate gyrus data of the anterior and posterior subregions were analyzed on a region-by-region basis, the mean z-score for the left anterior cingulate gyrus was significantly higher than that for the right cingulate gyrus (p < .05).

Conclusion: These results suggest that anterior cingulate cortex dysfunction may be involved in the pathology of FOG in patients with chronic lacunar infarction.
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http://dx.doi.org/10.3109/00207454.2012.672501DOI Listing
August 2012

Quantitative assessment of gait bradykinesia in Parkinson's disease using a portable gait rhythmogram.

Acta Med Okayama 2012 ;66(1):31-40

Department of Neurology, Tokyo Medical University, Shinjuku-ku, Japan.

To quantify gait bradykinesia during daily activity in patients with Parkinson's disease (PD), we measured movement-induced accelerations over more than 24h in 50 patients with PD and 17 age-matched normal controls, using a new device, the portable gait rhythmogram. Acceleration values induced by various movements, averaged each 10 min, exhibited a gamma distribution. The mean value of the distribution curve was used as an index of the "amount of overall movement per 24h". Characteristic changes were observed in both the gait cycle and gait acceleration. During hypokinesia, the gait cycle became either faster or slower. A number of patients with marked akinesia/bradykinesia showed a reduced and narrow range of gait acceleration, i.e., a range of floor reaction forces. The results suggest that assessment of the combination of changes in gait cycle and gait acceleration can quantitatively define the severity of gait bradykinesia.
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http://dx.doi.org/10.18926/AMO/48079DOI Listing
June 2012