Parkinson Disease
Conditions
Keywords
parkinson disease, music, imaging, mental singing, gait
Brief summary
Older adults, and particularly those with Parkinson disease (PD), may experience walking difficulties that negatively impact their daily function and quality of life. This project will examine the impact of music and mentally singing on walking performance, with a goal of understanding what types of rhythmic cues are most helpful. Our pilot work suggests that imagined, mental singing (i.e., singing in your head) while while walking helps people walk faster with greater stability, whereas walking to music also helps people walk faster but with reduced stability. In Aim 1, the investigators will compare walking while mentally singing to walking while listening to music, using personalized cues tailored to each person's walking performance. The investigators hypothesize stride time variability will be less in the mental singing condition compared to listening to music; and that mental singing and listening to music will improve gait speed similarly as compared to the uncued condition. The investigators will also test whether finger tapping, a rhythmic task similar to walking in many ways, responds similarly while mentally singing and listening to music. In Aim 2, the investigator will investigate the brain mechanisms underlying the enhancements in movement performance seen with mental signing or listening to music. The investigators will use magnetic resonance imaging (MRI) to measure brain activity during finger tapping with and without various cues to understand which areas of the brain are more or less responsive to the cues. The investigators hypothesize individuals with PD will exhibit lesser activation of putamen and greater activation of cortical motor areas and cerebellum compared to controls in all tapping conditions; and internal, mental singing during tapping will elicit greater activation of the putamen and lesser activation of cortical motor areas in both groups compared to uncued tapping and tapping while listening to music.
Detailed description
During this observational study, all participants will attend two visits 4-10 days apart. At the first visit, all participants (participants with PD and age-matched controls) will wear wearable sensors during the following tasks: walking with no cues; walking while listening to music; and walking while mentally singing. The wearable sensors will measure gait parameters including gait speed and stride time variability. All participants will also conduct the following tasks while finger tapping on a keyboard: tapping with no cues; tapping while listening to music; and tapping while mentally singing. At the second visit, all participants (participants with PD and age-matched controls) will perform the following tasks during imaging: uncued tapping; listening to music (no tapping); mentally singing (no tapping); listening to music and tapping; and mentally singing and tapping.
Interventions
BEHAVIORALMentally singing
All participants (people with PD and age-matched controls) sing their song in their head and match their footfalls or finger tapping to the beat.
BEHAVIORALListening to music
All participants (people with PD and age-matched controls) listen to their song and match their footfalls or finger tapping to the beat.
Sponsors
National Center for Complementary and Integrative Health (NCCIH)
Washington University School of Medicine
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
TREATMENT
Masking
DOUBLE (Investigator, Outcomes Assessor)
Eligibility
Sex/Gender
ALL
Age
30 Years to No maximum
Healthy volunteers
Yes
Inclusion criteria
for all participants: * at least 30 years of age; * willing and able to provide informed consent; * right-handed or ambidextrous; * normal hearing; * weight less than 250 lbs; and * able to walk for 10 continuous minutes independently. Inclusion criteria for participants with PD also include: * diagnosis of idiopathic, typical Parkinson disease according to the United Kingdom Brain Bank Criteria; * Hoehn & Yahr stages 2-3 (mild to moderate disease severity); * stable on all PD medications for at least 2 months prior to study entry; * a score of 1 or less on item # 7 on the New Freezing of Gait Questionnaire; and * score of ≥ 1 on the Movement Disorder Society - Unified Parkinson Disease Rating Scale (MDS-UPDRS)-III Item #10 indicating observable gait impairment.
Exclusion criteria
for both groups include: * diagnosis of any other neurological condition; * significant cognitive impairment; * unstable medical or concomitant illnesses or psychiatric conditions which, in the opinion of the investigators, would preclude successful participation; * cardiac problems that interfere with ability to safely participate (i.e., uncontrolled congestive heart failure, myocardial infarction in past 6 months, complex cardiac arrhythmias, significant left ventricular dysfunction, dyspnea on exertion, chest pain or pressure, resting tachycardia (\>100 beats/min); uncontrolled BP (resting systolic BP \>160 mmHg or diastolic BP \>100 mmHg)); * orthopedic problems in the lower extremities or spine that may limit walking (i.e., severe arthritis, spinal stenosis); * contraindications for magnetic resonance imaging (e.g., metallic implants); or * uncontrolled tremor or dyskinesia (while on PD medications if applicable).
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Gait Speed | Baseline | Measured with wearable sensors by APDM Wearable Technology |
| Stride Length Variability | Baseline | Measured with wearable sensors by APDM Wearable Technology |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Brain Activity (BOLD Signal) | Baseline | We analyzed the Blood Oxygen Level Dependent (BOLD) signal in the brain to determine where there were areas of significant changes in brain activity, relative to rest, when participants were moving with no cue (uncued), moving to the beat during self cueing (mental singing) and moving to the best during external cueing (music). BOLD values are reported are Beta weights. Positive values indicate an increase in activity relative to rest and negative values indicate a decrease in activity relative to rest. |
Countries
United States
Participant flow
Pre-assignment details
All participants in both groups completed all conditions (i.e., uncued, mental singing and music) at all tempos (i.e., 90, 100, 110 and 120% of baseline uncued cadence).
Participants by arm
| Arm | Count |
|---|---|
| Parkinson Group People living with Parkinson disease walking with and without rhythmic cues.
Mentally singing: All participants (people with PD and age-matched controls) sing their song in their head and match their footfalls or finger tapping to the beat.
Music: All participants (people with PD and age-matched controls) listen to their song and match their footfalls or finger tapping to the beat.
Uncued: no music and no singing | 29 |
| Healthy Control Group Healthy controls walking with and without rhythmic cues.
Mentally singing: All participants (people with PD and age-matched controls) sing their song in their head and match their footfalls or finger tapping to the beat.
Music: All participants (people with PD and age-matched controls) listen to their song and match their footfalls or finger tapping to the beat.
Uncued: no music and no singing | 29 |
| Total | 58 |
Baseline characteristics
| Characteristic | Parkinson Group | Healthy Control Group | Total |
|---|---|---|---|
| Age, Categorical <=18 years | 0 Participants | 0 Participants | 0 Participants |
| Age, Categorical >=65 years | 17 Participants | 16 Participants | 33 Participants |
| Age, Categorical Between 18 and 65 years | 12 Participants | 13 Participants | 25 Participants |
| Mini Mental Status Exam | 29 units on a scale | 29 units on a scale | 29 units on a scale |
| Race (NIH/OMB) American Indian or Alaska Native | 0 Participants | 0 Participants | 0 Participants |
| Race (NIH/OMB) Asian | 0 Participants | 0 Participants | 0 Participants |
| Race (NIH/OMB) Black or African American | 1 Participants | 1 Participants | 2 Participants |
| Race (NIH/OMB) More than one race | 0 Participants | 0 Participants | 0 Participants |
| Race (NIH/OMB) Native Hawaiian or Other Pacific Islander | 0 Participants | 0 Participants | 0 Participants |
| Race (NIH/OMB) Unknown or Not Reported | 0 Participants | 0 Participants | 0 Participants |
| Race (NIH/OMB) White | 28 Participants | 28 Participants | 56 Participants |
| Sex: Female, Male Female | 15 Participants | 15 Participants | 30 Participants |
| Sex: Female, Male Male | 14 Participants | 14 Participants | 28 Participants |
Adverse events
| Event type | EG000 affected / at risk | EG001 affected / at risk |
|---|---|---|
| deaths Total, all-cause mortality | 0 / 29 | 0 / 29 |
| other Total, other adverse events | 0 / 29 | 0 / 29 |
| serious Total, serious adverse events | 0 / 29 | 0 / 29 |
Outcome results
Primary
Gait Speed
Measured with wearable sensors by APDM Wearable Technology
Time frame: Baseline
Population: Results are presented separately for each group and for each cueing condition (uncued, music or mental singing) and tempo (90, 100, 110, 120%).
| Arm | Measure | Group | Value (MEAN) | Dispersion |
|---|---|---|---|---|
| Parkinson Disease Group | Gait Speed | Mental singing 120% | 1.27 meters per second | Standard Deviation 0.17 |
| Parkinson Disease Group | Gait Speed | Music 100% | 1.13 meters per second | Standard Deviation 0.16 |
| Parkinson Disease Group | Gait Speed | Music 90% | 1.04 meters per second | Standard Deviation 0.15 |
| Parkinson Disease Group | Gait Speed | Mental singing 100% | 1.13 meters per second | Standard Deviation 0.17 |
| Parkinson Disease Group | Gait Speed | Uncued | 1.12 meters per second | Standard Deviation 0.16 |
| Parkinson Disease Group | Gait Speed | Music 110% | 1.22 meters per second | Standard Deviation 0.19 |
| Parkinson Disease Group | Gait Speed | Mental singing 90% | 1.16 meters per second | Standard Deviation 0.16 |
| Parkinson Disease Group | Gait Speed | Mental singing 110% | 1.21 meters per second | Standard Deviation 0.17 |
| Parkinson Disease Group | Gait Speed | Music 120% | 1.29 meters per second | Standard Deviation 0.2 |
| Healthy Controls | Gait Speed | Mental singing 110% | 1.23 meters per second | Standard Deviation 0.16 |
| Healthy Controls | Gait Speed | Music 120% | 1.31 meters per second | Standard Deviation 0.17 |
| Healthy Controls | Gait Speed | Mental singing 120% | 1.29 meters per second | Standard Deviation 0.15 |
| Healthy Controls | Gait Speed | Uncued | 1.17 meters per second | Standard Deviation 0.13 |
| Healthy Controls | Gait Speed | Music 90% | 1.09 meters per second | Standard Deviation 0.15 |
| Healthy Controls | Gait Speed | Mental singing 90% | 1.11 meters per second | Standard Deviation 0.13 |
| Healthy Controls | Gait Speed | Music 100% | 1.17 meters per second | Standard Deviation 0.15 |
| Healthy Controls | Gait Speed | Mental singing 100% | 1.19 meters per second | Standard Deviation 0.15 |
| Healthy Controls | Gait Speed | Music 110% | 1.24 meters per second | Standard Deviation 0.16 |
Primary
Stride Length Variability
Measured with wearable sensors by APDM Wearable Technology
Time frame: Baseline
Population: Results are presented separately for each group in each condition (uncued, music, mental singing) at each tempo (90, 100, 110, 120% of uncued).
| Arm | Measure | Group | Value (MEAN) | Dispersion |
|---|---|---|---|---|
| Parkinson Disease Group | Stride Length Variability | Uncued | .014 coefficient of variation | Standard Deviation 0.003 |
| Parkinson Disease Group | Stride Length Variability | Music 110% | .014 coefficient of variation | Standard Deviation 0.009 |
| Parkinson Disease Group | Stride Length Variability | Music 100% | .013 coefficient of variation | Standard Deviation 0.005 |
| Parkinson Disease Group | Stride Length Variability | Mental singing 110% | .012 coefficient of variation | Standard Deviation 0.007 |
| Parkinson Disease Group | Stride Length Variability | Mental singing 90% | .013 coefficient of variation | Standard Deviation 0.006 |
| Parkinson Disease Group | Stride Length Variability | Music 120% | .016 coefficient of variation | Standard Deviation 0.009 |
| Parkinson Disease Group | Stride Length Variability | Mental singing 100% | .013 coefficient of variation | Standard Deviation 0.005 |
| Parkinson Disease Group | Stride Length Variability | Mental singing 120% | .012 coefficient of variation | Standard Deviation 0.005 |
| Parkinson Disease Group | Stride Length Variability | Music 90% | .015 coefficient of variation | Standard Deviation 0.005 |
| Healthy Controls | Stride Length Variability | Mental singing 120% | .011 coefficient of variation | Standard Deviation 0.005 |
| Healthy Controls | Stride Length Variability | Uncued | .013 coefficient of variation | Standard Deviation 0.005 |
| Healthy Controls | Stride Length Variability | Music 90% | .014 coefficient of variation | Standard Deviation 0.003 |
| Healthy Controls | Stride Length Variability | Mental singing 90% | .012 coefficient of variation | Standard Deviation 0.003 |
| Healthy Controls | Stride Length Variability | Music 100% | .014 coefficient of variation | Standard Deviation 0.004 |
| Healthy Controls | Stride Length Variability | Mental singing 100% | .011 coefficient of variation | Standard Deviation 0.002 |
| Healthy Controls | Stride Length Variability | Music 110% | .014 coefficient of variation | Standard Deviation 0.004 |
| Healthy Controls | Stride Length Variability | Mental singing 110% | .012 coefficient of variation | Standard Deviation 0.003 |
| Healthy Controls | Stride Length Variability | Music 120% | .014 coefficient of variation | Standard Deviation 0.006 |
Secondary
Brain Activity (BOLD Signal)
We analyzed the Blood Oxygen Level Dependent (BOLD) signal in the brain to determine where there were areas of significant changes in brain activity, relative to rest, when participants were moving with no cue (uncued), moving to the beat during self cueing (mental singing) and moving to the best during external cueing (music). BOLD values are reported are Beta weights. Positive values indicate an increase in activity relative to rest and negative values indicate a decrease in activity relative to rest.
Time frame: Baseline
Population: Results are presented separately for each group in each condition (uncued, music, mental singing).
| Arm | Measure | Group | Value (MEAN) | Dispersion |
|---|---|---|---|---|
| Parkinson Disease Group | Brain Activity (BOLD Signal) | Uncued Left Putamen | -.054 Beta weights (arbitrary units) | Standard Deviation 0.217 |
| Parkinson Disease Group | Brain Activity (BOLD Signal) | Uncued Right Putamen | -.053 Beta weights (arbitrary units) | Standard Deviation 0.181 |
| Parkinson Disease Group | Brain Activity (BOLD Signal) | Uncued Bilateral Primary Somatosensory Cortex | .069 Beta weights (arbitrary units) | Standard Deviation 0.26 |
| Parkinson Disease Group | Brain Activity (BOLD Signal) | Music Left Putamen | -.027 Beta weights (arbitrary units) | Standard Deviation 0.268 |
| Parkinson Disease Group | Brain Activity (BOLD Signal) | Music Right Putamen | -.069 Beta weights (arbitrary units) | Standard Deviation 0.199 |
| Parkinson Disease Group | Brain Activity (BOLD Signal) | Music Bilateral Auditory Cortex | .102 Beta weights (arbitrary units) | Standard Deviation 0.24 |
| Parkinson Disease Group | Brain Activity (BOLD Signal) | Music Bilateral Primary Somatosensory Cortex | .096 Beta weights (arbitrary units) | Standard Deviation 0.183 |
| Parkinson Disease Group | Brain Activity (BOLD Signal) | Mental singing Left Putamen | -.0001 Beta weights (arbitrary units) | Standard Deviation 0.272 |
| Parkinson Disease Group | Brain Activity (BOLD Signal) | Mental Singing Right Putamen | -.063 Beta weights (arbitrary units) | Standard Deviation 0.25 |
| Parkinson Disease Group | Brain Activity (BOLD Signal) | Mental singing Bilateral Primary Somatosensory Cortex | .177 Beta weights (arbitrary units) | Standard Deviation 0.291 |
| Healthy Controls | Brain Activity (BOLD Signal) | Mental singing Left Putamen | .114 Beta weights (arbitrary units) | Standard Deviation 0.296 |
| Healthy Controls | Brain Activity (BOLD Signal) | Uncued Left Putamen | -.017 Beta weights (arbitrary units) | Standard Deviation 0.189 |
| Healthy Controls | Brain Activity (BOLD Signal) | Music Bilateral Auditory Cortex | .246 Beta weights (arbitrary units) | Standard Deviation 0.357 |
| Healthy Controls | Brain Activity (BOLD Signal) | Uncued Right Putamen | -.053 Beta weights (arbitrary units) | Standard Deviation 0.143 |
| Healthy Controls | Brain Activity (BOLD Signal) | Mental singing Bilateral Primary Somatosensory Cortex | .258 Beta weights (arbitrary units) | Standard Deviation 0.394 |
| Healthy Controls | Brain Activity (BOLD Signal) | Uncued Bilateral Primary Somatosensory Cortex | .139 Beta weights (arbitrary units) | Standard Deviation 0.221 |
| Healthy Controls | Brain Activity (BOLD Signal) | Music Bilateral Primary Somatosensory Cortex | .218 Beta weights (arbitrary units) | Standard Deviation 0.279 |
| Healthy Controls | Brain Activity (BOLD Signal) | Music Left Putamen | .091 Beta weights (arbitrary units) | Standard Deviation 0.293 |
| Healthy Controls | Brain Activity (BOLD Signal) | Mental Singing Right Putamen | .024 Beta weights (arbitrary units) | Standard Deviation 0.279 |
| Healthy Controls | Brain Activity (BOLD Signal) | Music Right Putamen | .035 Beta weights (arbitrary units) | Standard Deviation 0.233 |