Efficacy of high-frequency rTMS in the treatment of gait disorder and cognition in patients with Parkinson's disease based on wearable devices and eye-movement assessments

Abstract

Background: Postural instability and gait disorder and cognitive dysfunction are common symptoms of Parkinson's disease (PD). Scale assessment is frequently used in the clinic to evaluate PD, but this technique is limited by its lack of sensitivity to changes in disease progression and its difficulty in capturing subtle movements and changes in cognitive function. It is currently believed that high-frequency repetitive transcranial magnetic stimulation (rTMS) can improve motor and cognitive dysfunction in patients with PD, though it remains controversial. Therefore, it is imperative to monitor and dynamically identify changes in postural instability and gait disorder, as well as those in cognitive dysfunction, in PD to develop targeted interventions. In this study, we observed the effect of high-frequency rTMS on gait disorders and cognitive functions in patients with PD by comparing data from wearable devices and eye-tracking devices before and after treatment.

Methods: A total of 159 patients with PD were included in this study. A GYENNO MATRIX wearable gait analyzer was used to monitor the objective gait data (including the timed up-and-go, narrow-track, and turning tests), the Eyeknow eye-tracking evaluation system was used to monitor the patient's eye movement cognition data (including the smooth pursuit, pro-saccade, and anti-saccade tests), and gait and cognitive function-related scales, including the Tinetti Balance Scale, Tinetti Gait Scale, Berg Balance Scale, Mini-Mental State Examination, and Montreal Cognitive Assessment (MoCA), were evaluated at the same time before and after high-frequency rTMS treatment.

Results: The mean step length, mean stride velocity, stride length, and mean step frequency of patients with PD in the timed up-and-go test all increased compared with those before rTMS treatment, whereas the mean stride time and double support decreased. In the narrow-track test, the mean stride velocity increased and the mean stride time decreased. In the turning test, the turning left duration, turning right duration, mean duration, mean number of steps, and average step duration decreased, while the mean angular velocity increased after rTMS treatment. Compared with those before rTMS treatment, the latency period of patients with PD in overlapping saccades decreased, the completion time of overlapping saccades decreased, and the average saccade speed increased. In the anti-saccade test, the completion time decreased and the average saccade speed increased after rTMS treatment. Compared with those before rTMS treatment, the Tinetti Balance Scale, Tinetti Gait Scale, Berg Balance Scale, Mini-Mental State Examination, and MoCA scores increased, and the MoCA sub-items improved in terms of visual-spatial and executive function, language, abstraction, delayed recall, and orientation after rTMS treatment.

Conclusion: High-frequency rTMS may be an effective therapy for improving gait disorders and cognitive functions in patients with PD.

Keywords: Parkinson’s disease; cognition; eye movement assessments; gait disorder; wearable gait analyzer.

Figure 1

Diagram of the Eyeknow. (a) Reflexive vision-guided scanning diagram: (1) the subject looks at the target point in the middle of the screen; (2) the target point appears randomly around the screen; and (3) the subject quickly looks at the random target point. (b) Anti- saccade diagram: (1) the subject looks at the target point that appears in the center of the screen; (2) the central target point disappears and a random target point appears around the screen; and (3) the subject looks in the opposite direction to the target point. (c) Smooth tracking diagram: the subjects looked at the target point and followed the target point to move at the same speed in the same direction until the target point disappeared.

Figure 2

Three assessments using the GYENNO MATRIX wearable device. (a) Timed up-and-go (TUG) test: the patients were instructed to stand up from a chair, walk in a straight line for 5 m at a comfortable speed, take a 180° turn at the 5-m marker, walk back to the starting point, take a 180° turn in front of the chair, and then sit back down on the chair. (b) Narrow-track test: the patients were instructed to pass through a narrow passage that was two fists wider than they were and walk in a straight line for 5 m at a comfortable speed. (c) Turning test: the patients were instructed to turn in a circle twice to the left and twice to the right.

Figure 3

Flowchart of the study design.