Author's School

School of Medicine

ORCID

https://orcid.org/0000-0003-0661-5340

Author's Department/Program

Movement Science

Language

English (en)

Date of Award

Spring 5-15-2024

Degree Type

Dissertation

Degree Name

Doctor of Philosophy (PhD)

Chair and Committee

Gammon M. Earhart

Committee Members

Catherine E. Lang, Joel S. Perlmutter, Keith R. Lohse, Michael D. Harris

Abstract

Neurodegenerative diseases are a group of disorders that impact the brain and lead to neuronal degeneration. This degeneration causes many different symptoms, which are often grouped into motor, cognitive, and psychiatric domains. Individuals with these disorders can experience symptoms from multiple domains at the same time, but little is known about how these distinct symptoms may impact each other.

In Chapter 2, we explored the intersection of balance and cognitive impairment in individuals with Alzheimer disease (AD). AD is traditionally discussed in the context of the dementia symptoms, but people with AD also experience motor deficits. Falls are a huge issue in this population, yet little is known about how measures of balance are related to falls in AD. We tested how individuals with AD perform on a standardized balance test and followed these individuals for twelve months to explore relationships between balance score and prospective falls.

Continuing to explore the overlap of cognitive impairment and motor deficits, in Chapter 3 we tested how individuals with Parkinson disease and comorbid dementia (PDD) respond to rhythmic auditory cueing (RAS). RAS has been used for many years in individuals with PD without dementia to improve gait, but little is known about how individuals with PDD respond to the same cueing methods. We utilized an established RAS methodology utilizing externally generated music cues and internally generated mental singing cues at four tempos to determine if individuals with PDD modulate their gait in response to RAS. This was done because individuals with PDD are often excluded from intervention studies, so little is known about the effectiveness of motor interventions in PDD.

In Chapter 4, we explored motor and non-motor symptoms in individuals with Huntington disease (HD). HD is a rare disease, and because of this, research is limited, particularly in the rehabilitation realm. Better understanding of the deficits present, and how they relate to each other, can help clinicians choose appropriate assessments and inform treatment. We collected measures of gait, balance, and physical activity in individuals with HD, and explored relationships among these domains. We also collected measures of cognitive impairment, impulsivity, and balance confidence in order to explore other influences on motor capacity and performance in this population.

Finally, in Chapter 5 we directly compared balance in individuals with AD, HD, and PD. All three of these disorders are neurodegenerative diseases, but, to our knowledge, balance function has never been directly compared among these populations. Given their overlapping symptoms including impaired balance but their distinct pathology, it could be useful to understand if there are specific differences in balance function across these populations. Additionally, as HD is a rare disease there is limited research in this population, so knowing how individuals with HD may be similar to other neurodegenerative disease populations could help inform treatment. In this study, we utilized data from three distinct cohort studies in order to directly compare across the three populations. This work could ultimately help clinicians choose appropriate assessments and treatments.

Together, the chapters included in this dissertation highlight the importance of thorough evaluation in individuals with neurodegenerative diseases. These individuals experience a complex web of symptoms that appear to influence each other. Better understanding of these relationships can improve assessment and treatment. Moreover, knowing that deficits in one area may be related to deficits in another domain can help hasten referrals to the appropriate specialties and improve patient care.

DOI

https://doi.org/10.48765/d7nh-3k25

Download

Share

COinS