Unified Parkinson’s Disease Rating Scale

Iv Complications Of Therapy

A. DYSKINESIAS

32. Duration: What proportion of the waking day are dyskinesias present?

0 = None.

33. Disability: How disabling are the dyskinesias?

0 = Not disabling.

34. Painful Dyskinesias: How painful are the dyskinesias?

0 = No painful dyskinesias.

35. Presence of Early Morning Dystonia

0 = No

36. Are off periods predictable?

0 = No

37. Are off periods unpredictable?

0 = No

38. Do off periods come on suddenly, within a few seconds?

0 = No

39. What proportion of the waking day is the patient off on average?

0 = None

40. Does the patient have anorexia, nausea, or vomiting?

0 = No

41. Any sleep disturbances, such as insomnia or hypersomnolence?

0 = No 1 = Yes

42. Does the patient have symptomatic orthostasis?

0 = No

What Is A Rating Scale

A rating scale is a means of providing information on a particular feature by assigning a value to it. In Parkinsons, rating scales require the rater to put a value to the feature or symptom in question, according to a set scale. The rater may be the person with Parkinsons or a healthcare professional.

Parkinsons rating scales are a means of assessing the symptoms of the condition. They provide information on the course of the condition and/or assess quality of life. They may also help to evaluate treatment and management strategies, which can be useful to researchers as well as to people with Parkinsons, their carers and medical team.

Motor scales are the best-known and most widely used, but non-motor symptom scales are equally important. Combined with a motor scale, these give a more balanced picture of how a person is affected by the condition. A low motor score may suggest that a person has mild Parkinsons but, at the same time, the person may have disabling non-motor symptoms, which impact on quality of life.

The Advantage Of Deep Learning

The dual-channel LSTM developed in our preliminary work provides only slightly higher performance than Gradient Tree Boosting with a 0.62 correlation vs. 0.61. However, transfer learning from the activity recognition dataset improves performance by providing a 10% higher correlation and 13% lower MAE when compared to Gradient Tree Boosting. This behavior indicates that temporal dependencies captured by the first two LSTM layers using hand-crafted features extracted from healthy subjects are beneficial to UPDRS-III estimation.

Another observation is that both the 1D and 2D CNN-LSTM networks outperform Gradient Tree with 0.70 and 0.67 correlation, respectively with greater than 10% increase in correlation, and 6.93 and 7.11 MAE, respectively, with a decrease of greater than 9% in MAE. These networks achieve comparable performance to the dual-channel LSTM with hand-crafted features, which means CNN could extract relevant data-driven features.

We also observe that the ensemble of the models based on hand-crafted and data-driven features improves the performance. The ensemble of multiple models is known to improve the regression results if the models solve different aspects of the given problem . Hence, we can conclude that the trained deep models are diverse and learn different views of the motion signals , and therefore, are necessary for successful UPDRS-III estimation.

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Parkinsons Disease Research Education And Clinical Centers

UNIFIED PARKINSON’S DISEASE RATING SCALE

Fahn S, Elton R, Members of the UPDRS Development Committee.In: Fahn S, Marsden CD, Calne DB, Goldstein M, eds.Recent Developments in Parkinson’s Disease, Vol 2. Florham Park, NJ. Macmillan Health Care Information 1987, pp 15 3-163, 293-304

I. MENTATION, BEHAVIOR AND MOOD

1. Intellectual Impairment

1 = Mild. Consistent forgetfulness with partial recollection of events and no other difficulties.2 = Moderate memory loss, with disorientation and moderate difficulty handling complex problems. Mild but definiteimpairment of function at home with need of occasional prompting.3 = Severe memory loss with disorientation for time and often to place. Severe impairment in handling problems.4 = Severe memory loss with orientation preserved to person only. Unable to make judgements or solve problems.Requires much help with personal care. Cannot be left alone at all.

2. Thought Disorder

0 = None.2 = “Benign” hallucinations with insight retained.3 = Occasional to frequent hallucinations or delusions without insight could interfere with daily activities.4 = Persistent hallucinations, delusions, or florrid psychosis. Not able to care for self.

3. Depression

1 = Periods of sadness or guilt greater than normal, never sustained for days or weeks.2 = Sustained depression .3 = Sustained depression with vegetative symptoms .4 = Sustained depression with vegetative symptoms and suicidal thoughts or intent.

4. Motivation/Initiative

5. Speech

6. Salivation

What Part Of The Body Is Most Affected By Parkinsons Disease

When nerve cells in the basal ganglia, an area of the brain that controls movement, become damaged or die, Parkinsons disease becomes more visible. Because dopamine is produced by these nerve cells, or neurons, they serve a specific function in the brain.

Parkinsons disease is a neurodegenerative disease in the United States, where Parkinsons disease is diagnosed in more than a million people. The disease is caused by the breakdown of dopamine-producing brain cells. Despite the fact that Parkinsons is not a well-defined cause, researchers believe that genetics and environment may play a role in it. People who have Parkinsons disease typically live for more than 60 years. Secondary symptoms, such as altered taste, decreased voice volume, and digestive issues, can all occur at this stage. Although Parkinsons disease is not fatal, falls, choking, or other mobility issues can pose a threat. If you suspect that you are suffering from Parkinsons, you should contact Tri-City Medical Center and schedule an appointment.

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How Are Other Body Systems Affected By Parkinsons Disease

Parkinsons disease has long been understood to cause a wide range of non-physical symptoms in addition to movement symptoms. The cardiac system, which includes the heart, as well as the major and minor blood vessels, is an organ system that is affected.

The Importance Of Dopamine In The Brain

Dopamine transports signals between brain cells and is required for communication. Low dopamine levels in the brain cause it to be unable to send signals that control movement. As the disease progresses, the patient may find it difficult to walk, speak, or swallow. There is no cure for Parkinsons disease, but there are treatments that can aid in its management. It is critical to identify and treat this disease as soon as possible because it can cause irreversible damage.

I Mentation Behavior And Mood

1. Intellectual Impairment

0 = None. 1 = Mild. Consistent forgetfulness with partial recollection of events and no other difficulties. 2 = Moderate memory loss, with disorientation and moderate difficulty handling complex problems. Mild but definite impairment of function at home with need of occasional prompting. 3 = Severe memory loss with disorientation for time and often to place. Severe impairment in handling problems. 4 = Severe memory loss with orientation preserved to person only. Unable to make judgements or solve problems. Requires much help with personal care. Cannot be left alone at all.

2. Thought Disorder

0 = None. 2 = Benign hallucinations with insight retained. 3 = Occasional to frequent hallucinations or delusions without insight could interfere with daily activities. 4 = Persistent hallucinations, delusions, or florrid psychosis. Not able to care for self.

3. Depression

1 = Periods of sadness or guilt greater than normal, never sustained for days or weeks. 2 = Sustained depression . 3 = Sustained depression with vegetative symptoms . 4 = Sustained depression with vegetative symptoms and suicidal thoughts or intent.

4. Motivation/Initiative

1 = Less assertive than usual more passive. 2 = Loss of initiative or disinterest in elective activities. 3 = Loss of initiative or disinterest in day to day activities. 4 = Withdrawn, complete loss of motivation.

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Unified Parkinson’s Disease Rating Scale

The unified Parkinson’s disease rating scale is used to follow the longitudinal course of Parkinson’s disease. The UPD rating scale is the most commonly used scale in the clinical study of Parkinson’s disease.

The UPDRS is made up of these sections:

• Part I: evaluation of mentation, behavior, and mood
• Part II: self-evaluation of the activities of daily life including speech, swallowing, handwriting, dressing, hygiene, falling, salivating, turning in bed, walking, and cutting food
• Part III: clinician-scored monitored motor evaluation
• Part IV: complications of therapy
• Part V: Hoehn and Yahr staging of severity of Parkinson’s disease
• Part VI: Schwab and England ADL scale

These are evaluated by interview and clinical observation. Some sections require multiple grades assigned to each extremity.

Clinicians and researchers alike use the UPDRS and the motor section in particular to follow the progression of a person’s Parkinson’s disease. Scientific researchers use it to measure benefits from a given therapy in a more unified and accepted rating system. Neurologists also use it in clinical practice to follow the progression of their patients’ symptoms in a more objective manner.

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Researching The Causes And Effects Of Parkinsons Disease

Parkinsons disease can be caused by a number of genetic and environmental factors, but no single cause exists. Although there is little known about the cause of the disease, it frequently runs in families and is not well understood. Some researchers, however, believe that the increased levels of toxins in the body, such as those produced by the Parkinsons-causing protein, could be a factor. Parkinsons disease is caused by a number of factors, including trembling, rigidity, and difficulty walking. The disease, on the other hand, can affect other organs in addition to the heart and blood vessels. The heart is particularly vulnerable to damage in Parkinsons patients, and the chances of having a heart attack or stroke are higher than those who do not have the disease. Despite the fact that Parkinsons disease causes and treatments have numerous side effects, there is little we know about its causes or treatments. Our ongoing research, however, continues to shed light on the diseases pathophysiology and reveal promising treatments that may improve the quality of life of those who are affected.

Comparison To Related Work

A review of the methods proposed for estimating the severity of PD is shown in Table . Comparing our algorithm to task-dependent approaches indicates that our method provides comparable performance with the advantage of not constraining PwPs activities. For example, it has a better correlation than Ref. with -0.56, equal or slightly lower than Refs. and lower than Ref. with 0.88. However, it is worth mentioning that the work in Ref. is based on performing a series of tasks using a smartphone application, while ours is solely based on movement data patterns.

Table 2 Proposed methods in the literature for estimating the severity of PD represented by UPDRS III

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Regression Models For Updrs

In our preliminary work, we explored two different architectures based on a single-channel and dual-channel LSTM of hand-crafted features and showed that the latter provides superior performance . In this section, we first describe an extension to that model by applying transfer learning using PAMAP2 dataset. Next, we develop a new 1D and 2D CNN-LSTM models using raw motion signals and their timefrequency representations, respectively. The proposed ensemble model is described next. Lastly, Gradient Tree Boosting is described as a traditional machine learning method for comparison purposes.

Dual-channel LSTM network with transfer learning

LSTM is a special type of Recurrent Neural Networks to overcome the vanishing gradient problem when training using gradient descent with backpropagation through time. LSTM can efficiently learn the temporal dependencies and has been successfully used in applications involving signals with temporal memory. In this work, LSTM architecture proposed by is used.

LSTM unit consists of input gate , input modulation gate , forget gate , output gate , and memory cell at time step t). Before applying the operations in these gates, current feature vector ) at time t in round r is linearly transformed using the following equation:

Does Parkinsons Affect Your Spine

Parkinsons Disease patients typically have a hunched posture and tilt to one side at times. A stooped posture places strain on the muscles in the lower back, resulting in an inability to keep the spine upright.

Pain that occurs in the central nervous system: This type of pain is the most common in people with Parkinsons disease. However, this can be a sign of other illnesses, such as tumors, but it is usually the result of Parkinsons disease. People suffering from Parkinsons disease are frequently unable to function in their daily lives due to pain in the central nervous system. When treating central pain in PD, the best treatment is to identify and treat the underlying cause of the condition. It can be difficult to achieve this, but medication and physical therapy can assist in the recovery process. Surgery may be required in some cases. In PD, there are no known cures, but medications, physical therapy, and, in some cases, surgery are the most effective treatments. If you have central pain, you should consult with your doctor to find out what to do.

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Schwab And England Activites Of Daily Living Scale

The Schwab and England ADL Scale is a means of measuring a persons ability to perform daily activities in terms of speed and independence through a percentage figure. The rating may be made by a professional or by the person being tested. High percentages indicate a high level of independence while low percentages indicate dependence:

• 100% – Completely independent. Able to do all activities without slowness, difficulty or impairment
• 90% – Completely independent. Able to do all activities with some slowness, difficulty or impairment. Activities may take twice as long to complete
• 80% – Independent in most activities, but activities take twice as long. Conscious of difficulty and slowing
• 70% – Not completely independent. More difficulty with activities, which may take three to four times as long. May take large part of day for chores
• 60% – Some dependency. Can do most activities, but very slowly and with much effort, but some chores are impossible
• 50% – More dependent. Help required with half of chores. Difficulty with everything
• 40% – Very dependent. Can assist with all chores but can manage few alone
• 30% – With effort, now and then does a few chores alone or begins alone. Much help needed
• 20% – Cannot do anything alone. Can give some slight help with some chores. Severe invalid
• 10% – Totally dependent, helpless
• 0% – Vegetative functions such as swallowing

What Body Parts Are Affected By Parkinson Disease

Parkinsons disease is a progressive, neurological disorder that affects nerve cells in the deep brain, particularly those in the basal ganglia and substantia nigra. The substantia nigra nerve cells, which produce the neurotransmitter dopamine, send messages that control body movements and planning.

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Limitations And Future Work

Our algorithm provides overall high performance for UPDRS-III estimation using patients free body movement data. However, we notice that the model underestimates high UPDRS-scores, as shown in Fig. . This is because of the imbalanced data distribution as there are only nine rounds of ADL with the UPDRS III score of higher than 40, and only one is above 50 . Parisi et al. reported a similar limitation due to the imbalance distribution of their training data toward the mean score of UPDRS III. Collecting more data in a home setting with a uniform data distribution is expected to improve our algorithms performance further and consists of the main aspect of our future work.

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Therapeutic Role Of Rtms In Parkinson Disease

Early studies suggested an improvement in pointing performance and on the Unified Parkinson Disease Rating Scale after rTMS to the motor cortex.101 Subthreshold rTMS applied to the motor cortex at both 0.5 Hz and 10 Hz improved motor performance.102 However, such changes lasted only for minutes. A long-lasting effect of rTMS may be obtained with repeated application over a period of days. In a randomized study, patients receiving 5-Hz rTMS to the motor cortex experienced improvements in the UPDRS motor scores, walking speed, and a self-assessment scale that persisted for over 1 month.103 In a double-blind, placebo-controlled study, rTMS over 4 weeks using four cortical targets in each session showed a therapeutic effect that lasted for at least 1 month after treatment ended.104

Low-frequency rTMS studies, by contrast, showed no significant reduction in motor UPDRS but may be a potential treatment for levodopa-induced dyskinesias.106 A single session of rTMS at 1 Hz to the supplementary motor area bilaterally lowered the severity of dyskinesias for 30 minutes after stimulation.108 Repeated administration of 1-Hz rTMS of the motor cortex109,110 and cTBS to the cerebellum111 have shown promise also as potential treatment for levodopa-induced dyskinesias.