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      Finger tapping impairments are highly sensitive for evaluating upper motor neuron lesions

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          Abstract

          Background

          Identifying highly sensitive and reliable neurological exam components are crucial in recognizing clinical deficiencies. This study aimed to investigate finger tapping performance differences between patients with CNS demyelinating lesions and healthy control subjects.

          Methods

          Twenty-three patients with multiple sclerosis or clinically isolated syndrome with infratentorial and/or cervical cord lesions on MRI, and 12 healthy controls were videotaped while tapping the tip of the index finger against the tip and distal crease of the thumb using both the dominant and non-dominant hand. Videos were assessed independently by 10 evaluators (three MS neurologists, four neurology residents, three advanced practice providers). Sensitivity and inter-evaluator reliability of finger tapping interpretations were calculated.

          Results

          A total of 1400 evaluations (four videos per each of the 35 subjects evaluated by 10 independent providers) were obtained. Impairments in finger tapping against the distal thumb crease of the non-dominant hand, identified by neurologists, had the greatest sensitivity (84%, p < 0.001) for detecting impairment. Finger tapping against the thumb crease was more sensitive than the thumb tip across all categories of providers. The best inter-evaluator reliability was associated with neurologists’ evaluations for the thumb crease of the non-dominant hand (kappa = 0.83, p < 0.001).

          Conclusions

          Impaired finger tapping against the distal thumb crease of the non-dominant hand was a more sensitive technique for detecting impairments related to CNS demyelinating lesions. Our findings highlight the importance of precise examinations of the non-dominant side where impaired fine motor control secondary to an upper motor injury might be detectable earlier than the dominant side.

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          Most cited references24

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          Influence of education and occupation on the incidence of Alzheimer's disease.

          Several cross-sectional studies have found an association between Alzheimer's disease (AD) and limited educational experience. It has been difficult to establish whether educational experience is a risk factor for AD because educational attainment can influence performance on diagnostic tests. This study was designed to determine whether limited educational level and occupational attainment are risk factors for incident dementia. Cohort incidence study. General community. A total of 593 nondemented individuals aged 60 years or older who were listed in a registry of individuals at risk for dementia in North Manhattan, NY, were identified and followed up. We reexamined subjects 1 to 4 years later with the identical standardized neurological and neuropsychological measures. Incident dementia. We used Cox proportional hazards models, adjusting for age and gender, to estimate the relative risk (RR) of incident dementia associated with low educational and occupational attainment. Of the 593 subjects, 106 became demented; all but five of these met research criteria for AD. The risk of dementia was increased in subjects with either low education (RR, 2.02; 95% confidence interval [Cl], 1.33 to 3.06) or low lifetime occupational attainment (RR, 2.25; 95% Cl, 1.32 to 3.84). Risk was greatest for subjects with both low education and low life-time occupational attainment (RR, 2.87; 95% Cl, 1.32 to 3.84). The data suggest that increased educational and occupational attainment may reduce the risk of incident AD, either by decreasing ease of clinical detection of AD or by imparting a reserve that delays the onset of clinical manifestations.
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            Education and the prevalence of dementia and Alzheimer's disease.

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              The concept of cognitive reserve: a catalyst for research.

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                Author and article information

                Contributors
                Afsaneh.Shirani@phhs.org
                Braeden.Newton@UTSouthwestern.edu
                (214) 645-0558 , Darin.Okuda@UTSouthwestern.edu
                Journal
                BMC Neurol
                BMC Neurol
                BMC Neurology
                BioMed Central (London )
                1471-2377
                21 March 2017
                21 March 2017
                2017
                : 17
                : 55
                Affiliations
                ISNI 0000 0000 9482 7121, GRID grid.267313.2, Department of Neurology and Neurotherapeutics, Clinical Center for Multiple Sclerosis, Multiple Sclerosis & Neuroimmunology Imaging Program, Neuroinnovation Program, , University of Texas Southwestern Medical Center, ; Dallas, TX 75390 USA
                Article
                829
                10.1186/s12883-017-0829-y
                5361720
                28327094
                efa6a3a1-1f91-4963-af69-50ef26198cad
                © The Author(s). 2017

                Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License ( http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

                History
                : 2 August 2016
                : 3 March 2017
                Categories
                Research Article
                Custom metadata
                © The Author(s) 2017

                Neurology
                finger tapping,neurological examination,upper motor neuron,multiple sclerosis,demyelinating,magnetic resonance imaging

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