Problems with Sustained Motor Performance in Parkinson's Disease and Effect of Neurofeedback: A Functional MRI Investigation

帕金森病的持续运动表现问题和神经反馈的影响：功能性 MRI 研究

基本信息

批准号：
10189712
负责人：
Sule Tinaz
金额：
$ 19.45万
依托单位：
YALE UNIVERSITY
依托单位国家：
美国
项目类别：
财政年份：
2019
资助国家：
美国
起止时间：
2019-07-01 至 2023-06-30
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/10189712
关键词：
Admission activity Adverse effects Aerobic Exercise Affect Anxiety Area Behavior Behavior Therapy Biometry Brain Brain region Clinical Trials Complex Conduct Clinical Trials Control Groups Corpus striatum structure Data Deep Brain Stimulation Development Plans Emotional Environment Feedback Functional Magnetic Resonance Imaging Functional disorder Goals Hospital Nursing Image Imagery Impairment Individual Infrastructure Insula of Reil Intervention Investigation Knowledge Learning Life Life Expectancy Magnetic Resonance Measures Mentors Methodology Mission Modification Morbidity - disease rate Motivation Motor Movement Movement Disorders National Institute of Neurological Disorders and Stroke Neurologist Neurology Nursing Homes Operative Surgical Procedures Outcome Parkinson Disease Pathologic Processes Pathology Patient Education Patients Performance Pharmacology Play Rehabilitation therapy Reporting Research Research Activity Research Project Grants Rest Role Scientist Severity of illness Signal Transduction Speed Symptoms Techniques Testing Time Training Training Activity Walking Writing addiction base career career development clinically significant design disability exercise program exercise rehabilitation falls frontal lobe functional MRI scan hands-on learning improved ineffective therapies medical schools motor disorder motor function improvement motor impairment motor symptom nervous system disorder neurofeedback neuroimaging neuropsychiatric disorder neuropsychiatry neuroregulation new therapeutic target novel novel therapeutic intervention post intervention programs recruit relating to nervous system response symptom treatment therapy development

项目摘要

7. Project Summary/Abstract Parkinson’s disease (PD) affects over six million individuals globally. With increasing life expectancy, this number is estimated to double by 2040. The impaired ability to sustain a steady motor performance is a major cause of morbidity in patients with PD. This is characterized by a rapid progressive decrement in the speed, amplitude, or force of movements during continuous tasks (e.g., walking, writing). The standard pharmacological and surgical therapies are ineffective in improving the decrement. There is a need for novel targeted therapies with minimal adverse effects for better symptom control. The goal of the proposed mentored research project is to assess the effects of functional magnetic resonance imaging (fMRI)-based neurofeedback intervention on brain plasticity and sustained motor performance in patients with PD. FMRI- based neurofeedback is a noninvasive intervention that improves individuals’ abilities to control their brain activity in real-time. With practice, individuals can also learn how to self-regulate behavior that is associated with this brain activity. This intervention has been used successfully in several neuropsychiatric disorders (e.g., anxiety, addiction), but reports of its use in PD are scant. Using fMRI-based neurofeedback combined with motor imagery, we will train patients with PD to increase the functional connectivity strength between their right insula and dorsomedial frontal cortex. These brain regions are important in initiating and sustaining voluntary movement and are affected by the pathological process in PD. We will examine the effects of this training on resting-state functional connectivity of brain networks and on motor performance. This proposal is in line with the NINDS mission to seek fundamental knowledge about the brain and nervous system and to use that knowledge to reduce the burden of neurological disease. If successful, this neurofeedback-guided motor imagery training could be incorporated into rehabilitation programs in PD. Candidate: Dr. Tinaz is a movement disorders neurologist. Her career goal is to develop a research program to study the neural basis of movement disorders, specifically PD, identify targets for novel therapies, and investigate the brain changes in response to interventions using neuroimaging. Dr. Tinaz seeks additional training in advanced fMRI methodology including neurofeedback, behavioral intervention development, biostatistics, and in design and conduct of clinical trials via didactic courses and hands-on learning. The project and career development plan will prepare her to design large-scale clinical trials to assess the efficacy of neurofeedback intervention in PD. Environment: The research and training activities will take place at Yale School of Medicine. The Magnetic Resonance Research Center at Yale is a state-of-the-art facility providing the infrastructure and interdisciplinary expertise for neuroimaging research. Dr. Tinaz’s mentors and consultants are experts on fMRI and clinical trial methodology. Upon completion of the proposed project, Dr. Tinaz will be well poised to become an independent clinician-scientist combining her expertise in movement disorders neurology and neuroimaging.

7. 项目总结/摘要随着预期寿命的延长，帕金森病 (PD) 影响着全球超过 600 万人。预计到 2040 年，这一数字将增加一倍。维持稳定运动表现的能力受损是一个主要问题 PD 患者发病的原因其特点是速度迅速进行性下降。连续任务（例如行走、写作）期间运动的幅度或力量。药物和手术治疗对于改善这种减少是无效的，因此需要新的治疗方法。所建议指导的目标是具有最小副作用的靶向治疗。研究项目是评估基于功能磁共振成像（fMRI）的效果神经反馈干预对 FMRI 患者大脑可塑性和持续运动表现的影响。基于神经反馈是一种非侵入性干预，可以提高个人控制大脑的能力通过练习，个人还可以学习如何自我调节相关行为。这种大脑活动已成功用于治疗多种神经精神疾病（例如，焦虑、成瘾），但使用基于功能磁共振成像的神经反馈结合治疗帕金森病的报道很少。运动想象，我们将训练帕金森病患者，以增加他们的右侧之间的功能连接强度岛叶和背内侧额叶皮层对于启动和维持自主意识很重要。运动并受到 PD 病理过程的影响。我们将检查这种训练对身体的影响。该提议符合大脑网络的静息态功能连接和运动表现。 NINDS 的使命是寻求并利用有关大脑和神经系统的基础知识如果成功的话，这种神经反馈引导的运动可以减轻神经系统疾病的负担。意象训练可以纳入 PD 康复计划中。候选人：Tinaz 博士是一项运动。她的职业目标是开发一个研究项目来研究运动的神经基础。疾病，特别是帕金森病，确定新疗法的目标，并研究大脑响应的变化 Tinaz 博士寻求高级功能磁共振成像方法的额外培训，包括神经反馈、行为干预开发、生物统计学以及临床试验的设计和实施通过教学课程和实践学习，该项目和职业发展计划将使她做好准备。设计大规模临床试验来评估神经反馈干预对帕金森病的疗效：环境。研究和培训活动将在耶鲁大学医学院进行。耶鲁大学中心是一个最先进的设施，为学生提供基础设施和跨学科专业知识 Tinaz 博士的导师和顾问都是功能磁共振成像和临床试验方面的专家。完成拟议项目后，蒂纳兹博士将做好成为一名专家的准备。独立临床医生科学家结合了她在运动障碍神经病学和神经影像学方面的专业知识。