Exogenous Effects of Standard Medical Care (Dopamine) on Motor Learning of an Upper Limb Task in Parkinson Disease

Utah System of Higher Education (USHE)

Status: Completed

Conditions: Parkinson Disease

Treatments: Behavioral: Upper limb feeding training

Study type: Interventional

Funder types: Other

Identifiers

NCT02600858

IRB_00085073_UL

Details and patient eligibility

About

The study determines whether standard medical care (dopamine) affects learning and retention of an upper limb feeding task in people with Parkinson's disease (PD) and whether training on the feeding task generalises to performance on an untrained upper limb buttoning task. Half the participants will train on the feeding task after they have taken their first dose of dopamine for the day (i.e. "on" medication state), while the other half will train on the same feeding task before taking their first daily dose of dopamine (i.e. "off" medication state).

Full description

Parkinson disease (PD) is an age related neurodegenerative disorder with symptomatic declines in motor function due to a loss of dopaminergic neurons within the basal ganglia.

Ironically, treatment with exogenous dopamine-replacement medication (e.g. levodopa) may have positive effects on existing motor skills such as handwriting or walking, but may have detrimental effects on the learning of motor skills necessary for effective rehabilitation.

Although dopamine medications are routinely prescribed to replace lost dopamine in the sensorimotor areas of the striatum, they may actually be "overdosing" the associative striatum, a candidate neuroanatomical correlate for motor learning. To date, however, this 'overdose' hypothesis has not been widely tested, given that few studies of motor learning in PD have reported or controlled for whether individuals were tested "on" or "off" their dopamine replacement medication.

Enrollment: 23 patients

Sex: All

Ages: 50 to 80 years old

Volunteers: No Healthy Volunteers

Inclusion criteria

• Idiopathic Parkinson's disease confirmed by neurologist
• Hoehn and Yahr stages 1 to 3
• On a stable dose of antiparkinsonian medication for the past month and will continue on this regime for at least another subsequent month
• Walks unaided

Exclusion criteria

• Not taking dopamine replacement therapy
• With prior surgical management for PD (e.g. deep brain stimulation)
• With medication-resistant freezing of gait
• Significant cognitive impairment (Montreal Cognitive Assessment score <18)
• Unstable medical conditions
• Other neurological conditions
• Unable to follow instructions or safely complete the training tasks

Trial design

Primary purpose: Supportive Care

Allocation: Randomized

Interventional model: Parallel Assignment

Masking: Single Blind

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23 participants in 2 patient groups

Training "off" medication

Experimental group

Description:

Participants will train on the upper limb feeding task before taking their first daily dose of standard dopamine medication for Parkinson's disease, i.e. while "off" dopamine replacement medication

Treatment:

Behavioral: Upper limb feeding training

Training "on" medication

Other group

Description:

Participants will train on the upper limb feeding task after taking their first daily dose of standard dopamine medication for Parkinson's disease, i.e. while "on" dopamine replacement medication

Treatment:

Behavioral: Upper limb feeding training