| 1. |
- Albrecht, Franziska, et al.
(författare)
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Effects of a Highly Challenging Balance Training Program on Motor Function and Brain Structure in Parkinson's Disease
- 2021
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Ingår i: Journal of Parkinson's Disease. - : IOS Press. - 1877-7171 .- 1877-718X. ; 11:4, s. 2057-2071
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Tidskriftsartikel (refereegranskat)abstract
- Background: Parkinson's disease (PD) is characterized by motor deficits and brain alterations having a detrimental impact on balance, gait, and cognition. Intensive physical exercise can induce changes in the neural system, potentially counteracting neurodegeneration in PD and improving clinical symptoms. Objective: This randomized controlled trial investigated effects of a highly challenging, cognitively demanding, balance and gait training (HiBalance) program in participants with PD on brain structure. Methods: 95 participants were assigned to either the HiBalance or an active control speech training program. The group-based interventions were performed in 1-hour sessions, twice per week over a 10-week period. Participants underwent balance, gait, cognitive function, and structural magnetic resonance imaging assessments before and after the interventions. Voxel-based morphometry was analyzed in 34 HiBalance and 31 active controls. Additionally, structural covariance networks were assessed. Results: There was no significant time by group interaction between the HiBalance and control training in balance, gait, or brain volume. Within-HiBalance-group analyses showed higher left putamen volumes post-training. In repeated measures correlation a positive linear, non-significant relationship between gait speed and putamen volume was revealed. In the HiBalance group we found community structure changes and stronger thalamic-cerebellar connectivity in structural covariance networks. Neither brain volume changes nor topology changes were found for the active controls after the training. Conclusion: Thus, subtle structural brain changes occur after balance and gait training. Future studies need to determine whether training modifications or other assessment methods lead to stronger effects.
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| 2. |
- Franzén, Erika, et al.
(författare)
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The EXPANd trial : effects of exercise and exploring neuroplastic changes in people with Parkinson's disease
- 2019
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Ingår i: BMC Neurology. - : Springer Science and Business Media LLC. - 1471-2377. ; 19:1
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Tidskriftsartikel (refereegranskat)abstract
- Background: Parkinson's disease (PD) affects many physiological systems essential for balance control. Recent studies suggest that intensive and cognitively demanding physical exercise programs are capable of inducing plastic brain changes in PD. We have developed a highly challenging balance training (the HiBalance) program that emphasizes critical aspects of balance control through progressively introducing more challenging exercises which incorporates dual-tasking. Earlier studies have shown it to be effective in improving balance, gait and dual-tasking. The study design has thereafter been adjusted to link intervention-induced behavioral changes to brain morphology and function. Specifically, in this randomized controlled trial, we will determine the effects of the HiBalance program on balance, gait and cognition and relate this to task-evoked functional MRI (fMRI), as well as brain-derived neurotrophic factor (BDNF) in participants with mild-moderate PD.Methods: One hundred participants with idiopathic PD, Hoehn & Yahr stage 2 or 3, >= 60 years of age, >= 21 on Montreal Cognitive Assessment will be recruited in successive waves and randomized into either the HiBalance program or to an active control group (the HiCommunication program, targeting speech and communication). Both interventions will be performed in small groups, twice a week with 1 h sessions for 10 weeks. In addition, a 1 h, once a week, home exercise program will also be performed. A double-blinded design will be used. At the pre- and post-assessments, participants will be assessed on balance (main outcome), gait, cognitive functions, physical activity, voice/speech function, BDNF in serum and fMRI (3 T Philips) during performance of motor-cognitive tasks.Discussion: Since there is currently no cure for PD, findings of neuroplastic brain changes in response to exercise would revolutionize the way we treat PD, and, in turn, provide new hope to patients for a life with better health, greater independence and improved quality of life.
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| 3. |
- Freidle, Malin, et al.
(författare)
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Measuring implicit sequence learning and dual task ability in mild to moderate Parkinson's disease: A feasibility study
- 2021
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Ingår i: PLoS ONE. - : Public Library of Science (PLoS). - 1932-6203. ; 16:5
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Tidskriftsartikel (refereegranskat)abstract
- We investigated the feasibility aspects of two choice reaction time tasks designed to assess implicit sequence learning and dual task ability in individuals with mild to moderate Parkinson's disease in comparison to healthy individuals. Twelve individuals with mild to moderate Parkinson's disease and 12 healthy individuals, all . 60 years of age, were included. A serial reaction time task was used as a measure of implicit sequence learning and a similar task but with the addition of a simple counting task, was used as a measure of dual task ability. We have present thorough descriptive statistics of the data but we have refrained from any inferential statistics due to the small sample size. All participants understood the task instructions and the difficulty level of both tasks was deemed acceptable. There were indications of task fatigue that demand careful choices for how best to analyse the data from such tasks in future trials. Ceiling effects were present in several accuracy outcomes, but not in the reaction time outcomes. Overall, we found both tasks to be feasible to use in samples of individuals with mild to moderate Parkinson's disease and healthy older individuals.
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| 4. |
- Freidle, Malin
(författare)
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Motor and cognitive abilities in Parkinson’s disease with a brain activity perspective : performance at baseline and the effects of a balance training program
- 2022
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Background: Around one per cent of the population over 60 years of age have Parkinson’s disease (PD). PD is a progressive and complicated disease presenting a wide range of symptoms. More knowledge of the common impairments in balance, gait, cognition, and motor learning is needed. There is also a need for more studies of physical exercise as a complement to pharmacological treatment for people with PD. Our research group has previously observed positive effects of a highly challenging balance training program (HiBalance) for people with PD in comparison to a passive control group. It is of considerable interest to further investigate the effects of the HiBalance program using an enhanced design quality such as an active control group, blinded assessors as well as by the inclusion of measures of brain activity and neuroprotective factors (BDNF). Aims: The first aim of this thesis was to develop feasible methods of investigating motor and cognitive abilities in people with PD as well as the effects of the HiBalance program. The second aim was to investigate motor and cognitive abilities as well as the effects of the HiBalance program for people with PD. This also included investigating the neural correlates of motor and cognitive baseline performances as well as the effects of the HiBalance program. Methods: In Paper I, feasibility aspects relating to the recruitment process, measurement methods, and the participants’ experience of the assessments and the two interventions to be used in Paper IV were investigated. In Paper II, feasibility aspects of two computer-based tasks created to measure implicit motor sequence learning and dual-task ability were investigated. These tasks were to be used in Paper III and IV for task-induced functional magnetic resonance imaging data. Feasibility aspects investigated included task fatigue, difficulty level and possible ceiling effects. In Paper III, people with PD and healthy individuals performed the implicit motor sequence learning task during the acquisition of functional magnetic resonance imaging data. In Paper IV, we investigated a wide range of outcomes of the HiBalance program for people with mild to moderate PD. Our primary outcome was balance and secondary outcomes included gait speed, executive functions, and measures of brain activity during implicit motor sequence learning as well as measures of the brain-derived neurotrophic factor. We used a double-blinded randomised controlled design with an active control group. Results: In Paper I, we found the feasibility of the randomised controlled design for investigating the HiBalance program to be overall acceptable but with some important modifications needed. In Paper II, we found the feasibility of the two computer-based tasks to be overall acceptable. In Paper III, we found support for the hypothesis that implicit motor sequence learning is impaired in people with PD. Exploratory analyses suggested that this impairment may be due to a lower learning rate. We found no statistically significant group changes in the task-induced brain activity. The results of Paper IV did not support the hypothesis of beneficial effects of the HiBalance program in comparison to our control group, for people with mild to moderate PD. Discussion: The two feasibility studies guided us in design aspects that needed improvement before use in Paper III and Paper IV. We hope that our feasibility studies can also help other researchers in their study designs and thereby decrease unnecessary efforts for study participants and increase the value of research investments. As for paper III, impaired motor sequence learning in people with PD is an interesting finding as motor learning ability is of crucial importance for motor performance. If implicit motor sequence learning has a lower learning rate in people with PD than healthy individuals, this could mean that people with PD need more time to practice and repeat when learning and doing motor tasks and physical exercise. As for paper IV, the lack of support for the HiBalance program in its investigated form is discouraging. This is however an important finding that we hope will spark future rigorous projects aiming to find interventions of physical exercise with robust, replicable positive effects for people with PD.
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| 5. |
- Freidle, Malin, et al.
(författare)
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No evidence for any effect of multiple sessions of frontal transcranial direct stimulation on mood in healthy older adults
- 2020
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Ingår i: Neuropsychologia. - : Elsevier BV. - 0028-3932 .- 1873-3514. ; 137
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Tidskriftsartikel (refereegranskat)abstract
- The dorsolateral prefrontal cortex (DLPFC) is part of a network important for emotional regulation and the possibility of modulating activity in this region with transcranial direct current stimulation (TDCS) to change mood has gained great interest, particularly for application in clinical populations. Whilst results in major depressive disorder have been promising, less is known about the effects of TDCS on mood in non-clinical populations. We hypothesized that multiple sessions of anodal TDCS applied over the left DLPFC would enhance mood, primarily as measured by the Profile of Mood States questionnaire, in healthy older adults. In addition, in an exploratory analysis, we examined the potentially moderating role of working memory training. Working memory, just like emotional regulation, taxes the DLPFC, which suggests that engaging in a working memory task whilst receiving TDCS may have a different effect on activity in this region and consequently mood. A total of 123 participants between 65 and 75 years of age were randomly assigned to receive either 20 sessions of TDCS, with or without working memory training, or 20 sessions sham stimulation, with or without working memory training. We found no support for enhancement of mood due to TDCS in healthy older adults, with or without cognitive training and conclude that the TDCS protocol used is unlikely to improve mood in non-depressed older individuals.
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| 6. |
- Johansson, Hanna, et al.
(författare)
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Feasibility aspects of exploring exercise-induced neuroplasticity in Parkinson's disease : A pilot randomized controlled trial
- 2020
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Ingår i: Parkinson's Disease. - : Hindawi Limited. - 2090-8083 .- 2042-0080. ; 2020
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Tidskriftsartikel (refereegranskat)abstract
- Background: Recent studies indicate that exercise can induce neuroplastic changes in people with Parkinson's disease (PwPD). Reports of feasibility outcomes from existing pilot trials however are, of date, insufficient to enable replication by others in larger definitive trials.Objective: To evaluate trial design for a definitive trial by exploring process and scientific feasibility.Methods: The trial design was a parallel-group RCT pilot with a 1 : 1 allocation ratio to either HiBalance or an active control group (HiCommunication). Both groups received one-hour sessions twice weekly, plus home exercises weekly, for 10 weeks. Participants with mild-to-moderate Parkinson's disease (PD) were recruited via advertisement. Assessment included physical performance, structural and functional MRI, blood sampling, neuropsychological assessment, and speech/voice assessment. Process and scientific feasibility were monitored throughout the study. Process feasibility involved recruitment, participant acceptability of assessments and interventions, assessment procedures (focus on imaging, blood sampling, and dual-task gait analysis), and blinding procedures. Scientific feasibility involved trends in outcome response and safety during group training and home exercises. Data are presented in median, minimum, and maximum values. Changes from pre- to postintervention are reported descriptively.Results: Thirteen participants were included (4 women, mean age 69.7 years), with a recruitment rate of 31%. Attendance rates and follow-up questionnaires indicated that both groups were acceptable to participate. Image quality was acceptable; however, diplopia and/or sleepiness were observed in several participants during MRI. With regard to dual-task gait performance, there appeared to be a ceiling effect of the cognitive tasks with seven participants scoring all correct answers at pretest. Blinding of group allocation was successful for one assessor but was broken for half of participants for the other.Conclusions: The overall trial design proved feasible to perform, but further strengthening ahead of the definitive RCT is recommended, specifically with respect to MRI setup, cognitive dual-tasks during gait, and blinding procedures. This trial is registered with NCT03213873.
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| 7. |
- Schwarz, Johanna F. A., et al.
(författare)
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Sleep in everyday life – relationship to mood and performance in young and older adults : a study protocol
- 2023
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Ingår i: Frontiers in Psychology. - : Frontiers Media S.A.. - 1664-1078. ; 14
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Tidskriftsartikel (refereegranskat)abstract
- Laboratory based sleep deprivation studies demonstrate that lack of sleep impairs well-being and performance ability, but suggest that these effects are mitigated in older adults. Yet, much less is known whether day-to-day variations of sleep have similar consequences in the context of everyday life. This project uses an intensive longitudinal design to investigate the occurrence of day-to-day variations in sleep and their impact on mood and performance in everyday life and to examine whether effects differ between young and older adults. We aim to include 160 young (18–30 years) and 160 older adults (55–75 years) to complete a 21-day experience sampling method (ESM) protocol. During the ESM period, participants are asked to fill in (i) a brief morning questionnaire, (ii) 8 short daytime questionnaires addressing momentary well-being, sleepiness, stress, and mind wandering, followed by a 1 min cognitive task and (iii) a brief evening questionnaire, all delivered via a mobile phone application. Sleep will be measured using self-reports (daily questions) and objectively with wrist actigraphy. The impact of adult age on mean levels and intraindividual variability of sleep will be analyzed using mixed-effects location scale models. The impact of sleep on daily cognitive performance will be analyzed using multilevel linear mixed models. The relationship of sleep to mean values and variability of positive and negative affect in young and older adults will be analyzed using mixed-effects location scale modeling. The overarching purpose of the project is improving the current knowledge on the occurrence of day-to-day variations in sleep and their relationship to performance as well as positive and negative affect in young and older adults.
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