Van Uem Janet M T, Walgaard Stefan, Ainsworth Erik, Hasmann Sandra E, Heger Tanja, Nussbaum Susanne, Hobert Markus A, Micó-Amigo Encarnación M, Van Lummel Rob C, Berg Daniela, Maetzler Walter
Hertie Institute for Clinical Brain Research, Department of Neurodegeneration, Center of Neurology, University of Tuebingen, Tuebingen, Germany.
DZNE, German Center for Neurodegenerative Diseases, Tuebingen, Germany.
PLoS One. 2016 Apr 7;11(4):e0151997. doi: 10.1371/journal.pone.0151997. eCollection 2016.
The instrumented-Timed-Up-and-Go test (iTUG) provides detailed information about the following movement patterns: sit-to-walk (siwa), straight walking, turning and walk-to-sit (wasi). We were interested in the relative contributions of respective iTUG sub-phases to specific clinical deficits most relevant for daily life in Parkinson's disease (PD). More specifically, we investigated which condition-fast speed (FS) or convenient speed (CS)-differentiates best between mild- to moderate-stage PD patients and controls, which parameters of the iTUG sub-phases are significantly different between PD patients and controls, and how the iTUG parameters associate with cognitive parameters (with particular focus on cognitive flexibility and working memory) and Health-Related-Quality of Life (HRQoL).
Twenty-eight PD participants (65.1 ± 7.1 years, H&Y stage 1-3, medication OFF state) and 20 controls (66.1 ± 7.5 years) performed an iTUG (DynaPort®, McRoberts BV, The Netherlands) under CS and FS conditions. The PD Questionnaire 39 (PDQ-39) was employed to assess HRQoL. General cognitive and executive functions were assessed using the Montreal Cognitive Assessment and the Trail Making Test.
The total iTUG duration and sub-phases durations under FS condition differentiated PD patients slightly better from controls, compared to the CS condition. The following sub-phases were responsible for the observed longer total duration PD patients needed to perform the iTUG: siwa, turn and wasi. None of the iTUG parameters correlated relevantly with general cognitive function. Turning duration and wasi maximum flexion velocity correlated strongest with executive function. Walking back duration correlated strongest with HRQoL.
This study confirms that mild- to moderate-stage PD patients need more time to perform the iTUG than controls, and adds the following aspects to current literature: FS may be more powerful than CS to delineate subtle movement deficits in mild- to moderate-stage PD patients; correlation levels of intra-individual siwa and wasi parameters may be interesting surrogate markers for the level of automaticity of performed movements; and sub-phases and kinematic parameters of the iTUG may have the potential to reflect executive functioning and HRQoL aspects of PD patients.
仪器辅助计时起立行走测试（iTUG）可提供有关以下运动模式的详细信息：从坐到走（siwa）、直线行走、转弯和从走到坐（wasi）。我们感兴趣的是iTUG各个子阶段对帕金森病（PD）日常生活中最相关的特定临床缺陷的相对贡献。更具体地说，我们研究了哪种条件——快速（FS）或适宜速度（CS）——能最好地区分轻度至中度PD患者与对照组，iTUG子阶段的哪些参数在PD患者和对照组之间存在显著差异，以及iTUG参数如何与认知参数（特别关注认知灵活性和工作记忆）及健康相关生活质量（HRQoL）相关联。
28名PD参与者（65.1±7.1岁，H&Y分期1 - 3期，未服药状态）和20名对照组（66.1±7.5岁）在CS和FS条件下进行iTUG测试（DynaPort®，McRoberts BV，荷兰）。采用帕金森病问卷39（PDQ - 39）评估HRQoL。使用蒙特利尔认知评估和连线测验评估一般认知和执行功能。
与CS条件相比，FS条件下iTUG总时长及子阶段时长能更好地区分PD患者与对照组。导致观察到的PD患者完成iTUG所需总时长较长的子阶段为：siwa、转弯和wasi。iTUG参数与一般认知功能均无显著相关性。转弯时长和wasi最大屈曲速度与执行功能的相关性最强。往回走的时长与HRQoL的相关性最强。
本研究证实轻度至中度PD患者完成iTUG所需时间比对照组更长，并在现有文献基础上补充了以下方面：在区分轻度至中度PD患者的细微运动缺陷方面，FS可能比CS更有效；个体内siwa和wasi参数的相关水平可能是所执行运动自动化程度的有趣替代指标；iTUG的子阶段和运动学参数可能有潜力反映PD患者的执行功能和HRQoL方面。
