The Efficacy of Exercise Programs for Parkinson’s Disease: Tai Chi versus Combined Exercise

천상명,채보경,성혜련,이건철,김재우 대한신경과학회 2013 Journal of Clinical Neurology Vol.9 No.4

Background and Purpose Exercise is recommended for every patient with Parkinson’s disease (PD). The effectiveness of two different forms of exercise for PD, Tai Chi and combined stretching-strengthening exercise, was compared. Methods Patients with mild-to-moderate PD were recruited to join either the combined stretching-strengthening exercise group (n=7), the Tai Chi group (n=9), or the control (nonintervention)group (n=7). Exercise was performed three times a week over a period of 8 weeks. The Tai Chi exercise was led by certified instructors based on a Tai-Chi-for-arthritis program. The combined stretching-strengthening exercise comprised folk dancing, stepping, and elastic-band exercises. The subjects’ functional fitness, parkinsonian symptoms, quality of life (QoL), and depression were evaluated. Results Both exercise groups yielded better results in their overall functional fitness after the intervention. However, no improvement with exercise was found for parkinsonian symptoms, as evaluated using the Unified Parkinson’s Disease Rating Scale. With respect to the domains of QoL, the combined stretching-strengthening exercise group fared better in the social domain of QoL, and the Tai Chi group fared better in the emotional domain, while QoL and depression worsened in the control group. The postintervention QoL was improved relative to the control condition only for the Tai Chi group. Although the exercise interventions did not have any effect on depression, the control group was associated with a significant deterioration. Conclusions Exercise improved the functional fitness and QoL of PD patients, with Tai Chi yielding better results in QoL and favorable results in functional fitness. These findings suggest that Tai Chi could be a good exercise strategy for patients with PD.

척수압박을 동반한 1형 뮤코다당체침착증 1예

천상명,박민정,차재관 대한신경과학회 2002 대한신경과학회지 Vol.20 No.2

Non-Motor Off Symptoms in Parkinson's Disease

천상명,박민정,김욱주,김재우 대한의학회 2009 Journal of Korean medical science Vol.24 No.2

The aim of this study is to elucidate the clinical spectrum and frequency of non-motor symptoms during off periods (NMOS) in Parkinson’s disease (PD) patients with motor fluctuation. We compared clinical characteristics between PD patients with motor symptoms only (M-off) and those with both motor and non-motor symptoms (NMoff) during off periods. The association of NMOS with parkinsonian clinical characteristics was also investigated. Sixty-seven consecutive PD patients of both M-off and NM-off groups were included in this study. We reviewed medical records, interviewed the patients, and administered a structured questionnaire. NMOS is classified into three categories: autonomic, neuropsychiatric and sensory. The frequency of NMOS and their individual manifestations were assessed. Of 67 patients with off symptoms, 20 were M-off group and 47 NM-off group. Among NMOS, diffuse pain was the most common manifestation, followed by anxiety and sweating. There were no significant differences between M-off and NM-off groups with regard to age, duration of disease and treatment, interval between onset of parkinsonian symptoms and off symptoms and off periods. Patients taking higher dosage of levodopa had fewer NMOS. NMOS is frequent in PD. Comprehensive recognition of NMOS can avoid unnecessary tests and is important for optimal treatment in PD.

렘수면 행동 장애와 퇴행성 신경계 질환

천상명 대한수면연구학회 2009 Journal of sleep medicine Vol.6 No.1

REM sleep behavior disorder (RBD) is characterized by dream-enacting violent behavior during REM sleep, which usually start at the age of older than 50. Patients with idiopathic RBD (IRBD) show various features similar to parkinsonian disorders and many of patients are known to be developing symptoms of neurodegenerative disorders in the course of disease. These close associations suggest that clinicians need to know the potential risk of developing parkinsonism and pay more attention to various features beyond sleep complaint when they manage the IRBD patient.

항혈소판제제에 따른 뇌경색 환잔의 혈소판 응집력의 차이

천상명,윤고운,박경원,김상호,김재우,신현철,차재관 대한신경과학회 2004 대한신경과학회지 Vol.22 No.1

Platelets play a key role in many occlusive vascular disorders and anti-platelet agents are the most important therapeutic strategy in preventing the recurrence of cerebral infarction. In order to know the platelet aggregability according to the strategy of anti-platelet agents, we measured platelet aggregability in patients who were taking anti-platelet agents for cerebral infarction. Methods: Platelet aggregability in response to adenosine diphosphate (ADP) or collagen was measured in whole blood samples from 175 patients (48 females and 137 males). It was analyzed according to the type of cerebral infarction, vascular risk factors, and each anti-platelet agent. Results: Platelet aggregability induced by ADP or collagen was significantly increased in patients with large artery atherosclerotic infarction compared to those with small vessel disease. Among anti-platelet regimens, combined therapy with aspirin and clopidogrel decreased platelet aggregability most effectively. Conclusions: These findings suggest that anti-platelet treatment should be tailored to the vascular status of each patient, and that combination therapy with aspirin and clopidogrel can effectively modulate platelet aggregability in preventing the recurrence of cerebral infarction

인간 신경 줄기세포 HB1.F3에서 alpha-synuclein과 synphilin-1 유전자 전이를 통한 봉입체 형성과세포 자멸사

천상명,이광,김재우,김승업 대한신경과학회 2007 대한신경과학회지 Vol.25 No.3

Background: The etiology of Parkinson’s disease (PD) has not been established, but familial forms of the disease have some clues for its pathogenesis. Autosomal dominantly inherited familial PD induced by aberrations of the alpha-synucein gene has been known as a genetic model of PD and sheds light to the understanding of PD pathogenesis. Synphilin-1 is a protein which interacts with alpha-synuclein and constitutes the Lewy body. Methods: Immortalized human neural stem cells were transfected with the alpha-synuclein gene and synphilin-1 gene, to define the role of Lewy body inclusions in neuronal cell death. Results: Human neural stem cells with Lewy body-like inclusions showed an increased apoptotic cell death compared to those with diffuse alpha-synuclein-positive and synphilin-1-positive reaction after transfection with the alpha-synuclein gene and synphilin-1 gene. Tyrosine hydroxylase over-expressing cells produced a high level of levodopa and showed a higher rate of the apoptotic marker. Conclusions: These results suggest that the formation of Lewy body-like inclusions by the over-expression of alpha-synuclein and synphilin-1 could be an underlying cause of apoptotic neuronal cell death and the dopaminergic cell might be more susceptible.

급성 뇌경색에서 혈소판 응집도의 변화

하병립,천상명,이경미,박경원,김상호,김재우,정민호,임영진,차재관 대한신경과학회 2003 대한신경과학회지 Vol.21 No.1

파킨슨병환자의 호흡기능, UPDRS 및 Senior Fitness의 관련성

강동연,천상명,성혜련,이경순,김경,Kang, Dong-Yeon,Cheon, Sang-Myung,Cheon, Sang-Myung,Lee, Kyung-Soon,Kim, Kyoung 대한물리치료학회 2014 대한물리치료학회지 Vol.26 No.2

Purpose: The purpose of this study was to examine correlations among UPDRS, respiratory function, and senior fitness and to investigate the effects of restrictive respiratory function on these factors in Parkinson's disease patients. Methods: Subjects (n=25, Hoehn & Yahr (H&Y) stage: 2-3, $69.3{\pm}5.9$ yrs) from D Hospital Parkinson's Disease Center at Busan metropolitan area in the Republic of Korea volunteered for this study. They performed the pulmonary function test, UPDRS, and the senior fitness test. SPSS 18.0 was used for analysis of data, and the collected data were analyzed using Pearson's correlation coefficient (n=25). In addition, Independent t-test was used for determination of differences between two groups (between the normal pulmonary function group (n=10) and the restrictive pulmonary function group (n=10)). Results: Forced vital capacity (FVC (L)) showed significant negative correlation (r=-0.44, p<0.05) with H&Y stage in Parkinson's disease patients, and chair stand showed significant negative correlations (r=0.41, 0.43, 0.42, p<0.05) with FVC (L), FVC (%), and FEV1 (L). FVC (%) showed significant positive correlations (r=0.44, r=0.44, p<0.05) with right and left back scratch. In addition, the restrictive respiratory function group showed significantly lower FVC (%) (p<0.01) and was significantly slower (p<0.05) in the 8-foot up-and-go test than the normal respiratory function group. Conclusion: In conclusion, these results suggest that restrictive respiratory function in PD was related to H&Y stage. In addition, agility of PD patients was lower in the restrictive respiratory function group than in the normal function group.

Effects of Sagittal Spinopelvic Alignment on Motor Symptom and Respiratory Function in Mild to Moderate Parkinson`s disease

강문선,천상명,성혜련,이혜영 대한물리치료학회 2019 대한물리치료학회지 Vol.31 No.2

Purpose: This study examined the effects of sagittal spinopelvic alignment on the clinical parameters, motor symptoms, and respiratory function in patients with mild to moderate Parkinson’s disease (PD). Methods: This study was a prospective assessment of treated patients (n=28, Hoehn and Yahr (H&Y) stage 2-3) in a PD center. Twentyeight subjects (68.5±5.7 yrs) participated in this study. The clinical and demographic parameters, including age, sex, symptoms duration, treatment duration, and H&Y stage, were collected. Kinematic analysis was conducted in the upright standing posture with a motion capture system. A pulmonary function test (PFT) was performed in the sitting position using a spirometer. The motor symptoms were assessed on part III of the movement disorder society sponsored version of the unified Parkinson’s disease rating scale (MDS-UPDRS). SPSS 18.0 was used to analyze the collected data. Results: The exceeding 12 degrees group of the lower trunk showed significantly higher on the clinical parameters than the below 12 degrees group. In addition, the exceeding 12 degrees group of the lower trunk showed a significantly lower forced expiratory volume at one second (FEV1) / forced vital capacity (FVC) (%) and 25-75% forced mid-expiratory flow (FEF) (L/s) than in the below group. On the other hand, there was no difference in the upper trunk and the cervical pelvis between the groups. Conclusion: These findings suggest that the sagittal balance in the lower trunk is related to the clinical parameters and respiratory function, but not the motor symptoms in patients with mild to moderate PD.

Cognitive Impairment in Parkinson’s Disease without Dementia: Subtypes and Influences of Age

김재우,천상명,박민정,조희영,김성연 대한신경과학회 2009 Journal of Clinical Neurology Vol.5 No.3

Background and Purpose Cognitive impairments are common in Parkinson’s disease (PD), although the severity of these impairments does not significantly impair the patient’s daily activities. The aim of this study was to determine the frequency of mild cognitive impairment (MCI) of Parkinson’s disease (PDMCI) and its subtypes in nondemented PD patients. We also evaluated the influence of age on the pattern of subtypes of PDMCI. Methods A total of 141 consecutive, nondemented PD patients underwent a comprehensive neuropsychological assessment covering the five cognitive domains: attention, language, visuospatial, memory, and executive functions. PDMCI was defined as impaired performance in at least one of these five cognitive domains. The influence of age on the distribution of subtypes of PDMCI was assessed by comparing patients in two groups dichotomized according to their age at assessment (younger vs. older). Results Fifty-seven (40.4%) of the nondemented PD patients had an impairment in at least one domain, and were therefore considered as having PDMCI. The age at assessment and age at disease onset were significantly higher in the PDMCI patients. The amnestic type of PDMCI was the most frequent, followed by the visuospatial, linguistic, executive, and attention types in that order. The frequency of PDMCI was higher for all subtypes in the older group; the domain that was influenced the most by age was executive function. Conclusions MCI was common in PD and the subtypes were diverse. Age was found to be an important risk factor for the development of PDMCI, particularly for the executive subtype. These results indicate that the concept of MCI should be introduced in PD.