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Thesis (Ph.D. in Clinical Science) -- University of Colorado Denver, 2008. / Typescript. Includes bibliographical references (leaves 59-67). Free to UCD Anschutz Medical Campus. Online version available via ProQuest Digital Dissertations;

Thesis (Ph. D.)--University of Washington, 1999. / Vita. Includes bibliographical references (leaves 69-75).

Abstract Autonomic nervous system (ANS) disturbances are common in Parkinson's disease (PD), but also in other Parkinsonian syndromes, especially in multiple system atrophy (MSA). The differentiation between various Parkinsonian syndromes may be difficult, but it is important for prognostic and therapeutic purposes. The aim of this study was to determine the ability of different analysis methods to reveal cardiovascular regulation disturbances in PD and to evaluate the diagnostic capacity of autonomic tests to differentiate between various Parkinsonian syndromes. Furthermore, this study aimed to evaluate the relationships between ANS disturbances and the clinical characteristics of PD. In addition, the cardiac autonomic function was evaluated during various sleep stages for the first time in untreated PD patients by using spectral heart rate variability (HRV) measures to determine possible sleep stage specific cardiovascular regulation disturbances. Cardiovascular autonomic reflexes were evaluated in 62 untreated and newly diagnosed PD patients, 34 PD patients under antiparkinsonian medication, 47 MSA patients and 15 patients with progressive supranuclear palsy (PSP). The usefulness of different analysis methods was evaluated in a subgroup of 32 untreated PD patients. A further 21 untreated PD patients underwent one-night polysomnography for nocturnal heart rate variability analysis. PD patients with hypokinesia/rigidity as their initial onset sign had a significantly lower max-min ratio in the deep breathing test than those patients with tremor as the initial sign. MSA patients showed significant reductions in both HRV and blood pressure responses during orthostatic provocation, whereas PSP patients had normal results. Absolute spectral measures yielded the clearest indicators separating the PD patients from the controls, while the cardiovascular reflexes proved more useful than the normalised spectral HRV measures in revealing the differences between the two groups. HRV was abnormally decreased during non-REM sleep in PD patients but not during REM sleep or the S1 sleep stage. The normalized high frequency power was significantly decreased in PD patients during sleep stages S2-4, while the standard deviation of the R-R intervals was increased during the same sleep stages, possibly corresponding to the increased motility of PD patients during these sleep stages. The clinical characteristics of PD deserve particular attention in connection with ANS disturbances, since autonomic failure seems to be more pronounced in PD patients with hypokinesia/rigidity as their initial sign. The evaluation of the autonomic function may also be helpful in the differential diagnosis of Parkinsonian syndromes. Spectral analysis methods should be implemented in the evaluation of ANS dysfunction to achieve the best possible efficacy in the differentiation of pathological responses from normal ones. Nocturnal analysis of cardiovascular regulation revealed new and interesting features of pathologic HRV in PD patients, thus when HRV is evaluated, the different sleep stages should be analysed separately.

Diss. (sammanfattning) Stockholm : Karol. inst., 2002. / Härtill 6 uppsatser.

Diss. (sammanfattning) Stockholm : Karolinska institutet, 2006. / Härtill 4 uppsatser.

Thesis (Ph. D.)--University of Texas Health Science Center at Houston, School of Public Health, 1994. / Includes bibliographical references (leaves 163-169).

Submitted by Carolina Favarin Soares (carolfavarin@gmail.com) on 2018-05-21T20:39:47Z No. of bitstreams: 1 carolina_favarin_soares_defesa_mestradoRC1.pdf: 2442261 bytes, checksum: 21d0aeb7750d84b057cb9517082d6140 (MD5) / Approved for entry into archive by Ana Paula Santulo Custódio de Medeiros null (asantulo@rc.unesp.br) on 2018-05-22T13:27:23Z (GMT) No. of bitstreams: 1 soares_cf_me_rcla.pdf: 2400648 bytes, checksum: 5b24db06fe320d1b36801d9b3a8db819 (MD5) / Made available in DSpace on 2018-05-22T13:27:23Z (GMT). No. of bitstreams: 1 soares_cf_me_rcla.pdf: 2400648 bytes, checksum: 5b24db06fe320d1b36801d9b3a8db819 (MD5) Previous issue date: 2018-03-20 / Introdução: O Brasil foi classificado como o quinto país com maior taxa de mortalidade decorrente de atropelamentos, na qual 52 % da população com mais de 60 anos de idade é acometida. A população afetada pela Doença de Parkinson (DP) possui déficits atencionais e na realização da dupla tarefa motora que aumentam o risco de atropelamentos, uma vez que além dos déficits motores, a capacidade de tomada de decisão e a resposta aos estímulos externos estão prejudicados. Objetivo: Analisar as características cinemáticas da marcha durante o desvio de obstáculo e realização de dupla tarefa motora de indivíduos com e sem a DP durante a simulação de travessia de rua. Métodos: Participaram do estudo 18 indivíduos sem alteração neurológica (grupo controle) e 18 indivíduos com DP idiopática que realizavam marcha independente. Os participantes atravessaram a passarela por cinco vezes em seis condições de marcha distintas que foram randomizadas por um dos avaliadores. As condições consistiam em marcha sem realizar tarefa concomitante (MN), marcha com desvio de obstáculo (MO), marcha com travessia de rua sem realizar tarefa concomitante (MNT), marcha com travessia carregando sacolas (MTS), marcha com travessia de rua desviando de obstáculo (MTO) e marcha com travessia de rua desviando de obstáculo e carregando sacolas (MTSO). A travessia de rua foi simulada por meio de um farol e um projetor e a coleta dos dados cinemáticos da marcha foi realizada pelo sistema de câmeras VICON® que coletou com frequência de amostragem de 100 Hz. Para análise estatística foi aplicado o teste de ANOVA para medidas repetidas com Post Hoc de Bonferroni adotando nível de significância de p < 0,05. Resultados: O grupo com DP apresentou comportamento da marcha mais prejudicado do que o grupo controle na variável duração de passo (s) (F= 2,572, p= 0,029). Já as comparações intragrupos tiveram diferença significativa entre as diferentes condições de marcha nas variáveis comprimento de passo (cm) (F=13,245, P<0,001), largura do passo (cm) (F=4,361, p=0,001), duração do passo (s) (F=2,879, p=0,016), velocidade do passo (cm/s) (F=3,995,p=0,002) e porcentagem de duplo suporte (%) (F=22,053, p=0,000) mostrando parâmetros cinemáticos da marcha com desvio de obstáculo pior do que marcha sem o desvio. Discussão: Indivíduos com DP apresentam dificuldade em se adaptar em condições que exigem maior foco atencional, como o desvio de obstáculo, isso ocorre por sua função executiva estar mais prejudicada do que no grupo controle. Além disso, a marcha carregando sacolas pode ter atuado de forma a melhorar a propriocepção do indivíduo durante a travessia. Conclusão: Indivíduos com DP apresentam valores de parâmetros cinemáticos da marcha menores do que o grupo controle e a marcha com desvio de obstáculo pode promover maiores déficits de parâmetros cinemáticos da marcha predispondo a um maior risco de atropelamentos. / Introduction: Brazil was ranked as the fifth country with the highest mortality rate due to road accidents such trampling, affecting 52% of the population over 60 years of age. The population affected by Parkinson's disease (PD) has deficits in attention and in the accomplishment of the double motor task that increases the risk of run over, since besides the motor deficits, the capacity of decision making and the response to the external stimulus are impaired. Objective: To analyze the kinematic characteristics of the gait during the obstacle deviation and the accomplishment of double motor task of individuals with and without PD during the simulation of street crossing. Methods: 18 individuals without neurological alterations and 18 individuals with idiopathic PD who performed independent gait participated in the study. Participants crossed the runway five times in six distinct gait conditions that were randomized by one of the raters. The conditions consisted of walking without concomitant task (MN), walking with obstacle bypass (MO), walking with street crossing without carrying out concomitant task (MNT), walking with crossing carrying bags (MTS), walking with crossing the street bypassing obstacle course (MTO) and road crossing with obstacle distraction and carrying bags (MTSO). The street crossing was simulated by means of a headlamp and a projector and the kinematic data of the gait was collected by the VICON® camera system, which was collected with a sampling frequency of 100 Hz. For statistical analysis, the ANOVA test was applied for repeated measures with Bonferroni’s Post Hoc adopting significance level of p <0.05. Results: The group with PD presented gait behavior more impaired than the control group in the step duration variable (F = 2,572, p = 0.029). Intragroup comparisons had a significant difference between the different gait conditions in the step length (cm) variables (F = 13.245, P <0.001), step width (cm) (F = 4,361, p = 0.001) (F = 2.879, p = 0.016), step velocity (cm / s) (F = 3.995, p = 0.002) and double support percentage (%) (F = 22.053, p = 0.000) showing kinematic parameters of the gait with obstacle deviation worse than gait without deviation. Discussion: Individuals with PD present difficulties in adapting to conditions that require greater attention focus, such as obstacle deviation, because their executive function is more impaired than in the CG. In addition, the gait carrying bags may have acted in a way to improve the individual's proprioception during the crossing. Conclusion: Individuals with PD present values of gait kinematic parameters lower than the GC, and gait with obstacle deviation can promote highest deficits in gait kinematic parameters, predisposing to a higher risk of running over.

Parkinsonian syndrome is an umbrella term including several diseases with similar symptoms. PET images are key when differential diagnosing patients with parkinsonsian syndrome. In this work two automatic diagnosing models are developed and evaluated, with PET images as input, and a diagnosis as output. The two devoloped models are evaluated based on performance, in terms of sensitivity, specificity and misclassification error. The models consists of 1) regression model and 2) either a decision tree or a random forest. Two coefficients, alpha and beta, are introduced to train and test the models. The coefficients are the output from the regression model. They are calculated with multiple linear regression, with the patient images as dependent variables, and mean images of four patient groups as explanatory variables. The coefficients are the underlying relationship between the two. The four patient groups consisted of 18 healthy controls, 21 patients with Parkinson's disease, 17 patients with dementia with Lewi bodies and 15 patients with vascular parkinsonism. The models predict the patients with misclassification errors of 27% for the decision tree and 34% for the random forest. The patient group which is easiest to classify according to both models is healthy controls. The patient group which is hardest to classify is vascular parkinsonism. These results implies that alpha and beta are interesting outcomes from PET scans, and could, after further development of the model, be used as a guide when diagnosing in the models developed.

京都大学 / 0048 / 新制・論文博士 / 博士(医学) / 乙第12945号 / 論医博第2097号 / 新制||医||1010(附属図書館) / 32204 / (主査)教授 髙橋 良輔, 教授 富樫 かおり, 教授 髙橋 淳 / 学位規則第4条第2項該当 / Doctor of Medical Science / Kyoto University / DFAM