{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,1]],"date-time":"2026-10-01T16:57:10Z","timestamp":1790873830794,"version":"4.1.0"},"reference-count":44,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2024,10,16]],"date-time":"2024-10-16T00:00:00Z","timestamp":1729036800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Aging Neurosci."],"abstract":"<jats:sec><jats:title>Background<\/jats:title><jats:p>Postural instability and gait disorder and cognitive dysfunction are common symptoms of Parkinson\u2019s disease (PD). Scale assessment is frequently used in the clinic to evaluate PD, but this technique is limited by its lack of sensitivity to changes in disease progression and its difficulty in capturing subtle movements and changes in cognitive function. It is currently believed that high-frequency repetitive transcranial magnetic stimulation (rTMS) can improve motor and cognitive dysfunction in patients with PD, though it remains controversial. Therefore, it is imperative to monitor and dynamically identify changes in postural instability and gait disorder, as well as those in cognitive dysfunction, in PD to develop targeted interventions. In this study, we observed the effect of high-frequency rTMS on gait disorders and cognitive functions in patients with PD by comparing data from wearable devices and eye-tracking devices before and after treatment.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>A total of 159 patients with PD were included in this study. A GYENNO MATRIX wearable gait analyzer was used to monitor the objective gait data (including the timed up-and-go, narrow-track, and turning tests), the Eyeknow eye-tracking evaluation system was used to monitor the patient\u2019s eye movement cognition data (including the smooth pursuit, pro-saccade, and anti-saccade tests), and gait and cognitive function\u2013related scales, including the Tinetti Balance Scale, Tinetti Gait Scale, Berg Balance Scale, Mini-Mental State Examination, and Montreal Cognitive Assessment (MoCA), were evaluated at the same time before and after high-frequency rTMS treatment.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>The mean step length, mean stride velocity, stride length, and mean step frequency of patients with PD in the timed up-and-go test all increased compared with those before rTMS treatment, whereas the mean stride time and double support decreased. In the narrow-track test, the mean stride velocity increased and the mean stride time decreased. In the turning test, the turning left duration, turning right duration, mean duration, mean number of steps, and average step duration decreased, while the mean angular velocity increased after rTMS treatment. Compared with those before rTMS treatment, the latency period of patients with PD in overlapping saccades decreased, the completion time of overlapping saccades decreased, and the average saccade speed increased. In the anti-saccade test, the completion time decreased and the average saccade speed increased after rTMS treatment. Compared with those before rTMS treatment, the Tinetti Balance Scale, Tinetti Gait Scale, Berg Balance Scale, Mini-Mental State Examination, and MoCA scores increased, and the MoCA sub-items improved in terms of visual\u2013spatial and executive function, language, abstraction, delayed recall, and orientation after rTMS treatment.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>High-frequency rTMS may be an effective therapy for improving gait disorders and cognitive functions in patients with PD.<\/jats:p><\/jats:sec>","DOI":"10.3389\/fnagi.2024.1480171","type":"journal-article","created":{"date-parts":[[2024,10,16]],"date-time":"2024-10-16T05:30:41Z","timestamp":1729056641000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":3,"title":["Efficacy of high-frequency rTMS in the treatment of gait disorder and cognition in patients with Parkinson\u2019s disease based on wearable devices and eye-movement assessments"],"prefix":"10.3389","volume":"16","author":[{"given":"Hong Yin","family":"Tang","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"XiangLian","family":"Liao","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Peng","family":"Li","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pengfei","family":"Zhang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jian","family":"Yao","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yilan","family":"Xing","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xin","family":"Zhao","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xuying","family":"He","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jie","family":"Zan","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Guihua","family":"Li","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2024,10,16]]},"reference":[{"key":"ref1","doi-asserted-by":"publisher","first-page":"217","DOI":"10.1038\/nrneurol.2017.27","article-title":"Cognitive decline in Parkinson disease","volume":"13","author":"Aarsland","year":"2017","journal-title":"Nat. Rev. Neurol."},{"key":"ref2","doi-asserted-by":"publisher","first-page":"1475","DOI":"10.1016\/j.neuropsychologia.2005.11.015","article-title":"Dissociating cognitive deficits involved in voluntary eye movement dysfunctions in Parkinson's disease patients","volume":"44","author":"Amador","year":"2006","journal-title":"Neuropsychologia"},{"key":"ref3","doi-asserted-by":"publisher","first-page":"226","DOI":"10.1016\/j.expneurol.2008.04.001","article-title":"Cortico-basal ganglia-cortical circuitry in Parkinson's disease reconsidered","volume":"212","author":"Braak","year":"2008","journal-title":"Exp. Neurol."},{"key":"ref4","doi-asserted-by":"publisher","first-page":"1907","DOI":"10.1212\/WNL.0000000000003279","article-title":"Multifocal repetitive TMS for motor and mood symptoms of Parkinson disease","volume":"87","author":"Brys","year":"2016","journal-title":"Neurology"},{"key":"ref5","doi-asserted-by":"publisher","first-page":"309","DOI":"10.1016\/S0165-0173(01)00158-8","article-title":"Transcranial magnetic stimulation and Parkinson's disease","volume":"38","author":"Cantello","year":"2002","journal-title":"Brain Res. Brain Res. Rev."},{"key":"ref6","doi-asserted-by":"publisher","first-page":"838","DOI":"10.3389\/fneur.2020.00838","article-title":"Transverse strips instead of wearable laser lights alleviate the sequence effect toward a destination in Parkinson's disease patients with freezing of gait","volume":"11","author":"Cao","year":"2020","journal-title":"Front. Neurol."},{"key":"ref7","doi-asserted-by":"publisher","first-page":"190","DOI":"10.19738\/j.cnki.psy.2018.08.168","article-title":"Comparison of the therapeutic effects of high-frequency and low-frequency repetitive transcranial magnetic stimulation on depression in Parkinson's disease","volume":"2018","author":"Chen","year":"2018","journal-title":"Psychol. Monthly"},{"key":"ref8","doi-asserted-by":"publisher","first-page":"475","DOI":"10.1016\/j.brs.2016.03.017","article-title":"Effect of repetitive transcranial magnetic stimulation on physical function and motor signs in Parkinson's disease: a systematic review and meta-analysis","volume":"9","author":"Chung","year":"2016","journal-title":"Brain Stimul."},{"key":"ref9","doi-asserted-by":"publisher","first-page":"933","DOI":"10.1002\/ana.25881","article-title":"Transcranial magnetic stimulation promotes gait training in Parkinson disease","volume":"88","author":"Chung","year":"2020","journal-title":"Ann. Neurol."},{"key":"ref10","doi-asserted-by":"publisher","first-page":"Iv32","DOI":"10.1007\/s00415-006-4008-0","article-title":"Scales in Parkinson's disease","volume":"253","author":"Ebersbach","year":"2006","journal-title":"J. Neurol."},{"key":"ref11","doi-asserted-by":"publisher","first-page":"3472","DOI":"10.3760\/cma.j.cn112137-20200302-00539","article-title":"Classification of gait disorders in Parkinson's disease and individualized rehabilitation strategies","volume":"43","author":"Fang","year":"2020","journal-title":"Chin. Med. J."},{"key":"ref12","doi-asserted-by":"publisher","first-page":"43","DOI":"10.1016\/j.cortex.2021.02.024","article-title":"Effects of rTMS on the brain: is there value in variability?","volume":"139","author":"Goldsworthy","year":"2021","journal-title":"Cortex"},{"key":"ref13","doi-asserted-by":"publisher","first-page":"715","DOI":"10.1016\/j.conb.2004.10.010","article-title":"Contributions of functional imaging to understanding parkinsonian symptoms","volume":"14","author":"Grafton","year":"2004","journal-title":"Curr. Opin. Neurobiol."},{"key":"ref14","doi-asserted-by":"publisher","first-page":"1524","DOI":"10.1002\/mds.22168","article-title":"High\u2010frequency rTMS over the supplementary motor area for treatment of Parkinson's disease","volume":"23","author":"Hamada","year":"2008","journal-title":"Mov. Disord."},{"key":"ref15","doi-asserted-by":"publisher","first-page":"368","DOI":"10.1136\/jnnp.2007.131045","article-title":"Parkinson\u2019s disease: clinical features and diagnosis","volume":"79","author":"Jankovic","year":"2008","journal-title":"J. Neurol. Neurosurg. Psychiatry"},{"key":"ref16","doi-asserted-by":"publisher","first-page":"377","DOI":"10.1186\/s12883-020-01953-4","article-title":"Effect of rTMS on Parkinson\u2019s cognitive function: a systematic review and meta-analysis","volume":"20","author":"Jiang","year":"2020","journal-title":"BMC Neurol."},{"key":"ref17","doi-asserted-by":"publisher","first-page":"2201","DOI":"10.1002\/mds.21089","article-title":"Effect of daily repetitive transcranial magnetic stimulation on motor performance in Parkinson's disease","volume":"21","author":"Khedr","year":"2006","journal-title":"Mov. Disord."},{"key":"ref18","doi-asserted-by":"publisher","first-page":"521","DOI":"10.3233\/RNN-140489","article-title":"Efficacy of cumulative high-frequency rTMS on freezing of gait in Parkinson\u2019s disease","volume":"33","author":"Kim","year":"2015","journal-title":"Restor. Neurol. Neurosci."},{"key":"ref19","doi-asserted-by":"publisher","first-page":"474","DOI":"10.1016\/j.clinph.2019.11.002","article-title":"Evidence-based guidelines on the therapeutic use of repetitive transcranial magnetic stimulation (rTMS): an update (2014\u20132018)","volume":"131","author":"Lefaucheur","year":"2020","journal-title":"Clin. Neurophysiol."},{"key":"ref20","doi-asserted-by":"publisher","first-page":"2530","DOI":"10.1016\/j.clinph.2004.05.025","article-title":"Improvement of motor performance and modulation of cortical excitability by repetitive transcranial magnetic stimulation of the motor cortex in Parkinson's disease","volume":"115","author":"Lefaucheur","year":"2004","journal-title":"Clin. Neurophysiol."},{"key":"ref21","doi-asserted-by":"publisher","first-page":"106979","DOI":"10.1016\/j.parkreldis.2024.106979","article-title":"Combined diagnosis for Parkinson's disease via gait and eye movement disorders","volume":"123","author":"Li","year":"2024","journal-title":"Parkinsonism Relat. Disord."},{"key":"ref22","doi-asserted-by":"publisher","first-page":"105791","DOI":"10.1016\/j.parkreldis.2023.105791","article-title":"Abnormal eye movements in Parkinson's disease: from experimental study to clinical application","volume":"115","author":"Li","year":"2023","journal-title":"Parkinsonism Relat. Disord."},{"key":"ref23","doi-asserted-by":"publisher","first-page":"1089","DOI":"10.1002\/alz.13517","article-title":"A detection model of cognitive impairment via the integrated gait and eye movement analysis from a large Chinese community cohort","volume":"20","author":"Lin","year":"2024","journal-title":"Alzheimers Dement."},{"key":"ref24","doi-asserted-by":"publisher","first-page":"325","DOI":"10.1002\/mds.20713","article-title":"Placebo\u2010controlled study of rTMS for the treatment of Parkinson's disease","volume":"21","author":"Lomarev","year":"2006","journal-title":"Mov. Disord."},{"key":"ref25","doi-asserted-by":"publisher","first-page":"3338","DOI":"10.1016\/j.neuropsychologia.2012.09.025","article-title":"The influence of motor and cognitive impairment upon visually-guided saccades in Parkinson's disease","volume":"50","author":"MacAskill","year":"2012","journal-title":"Neuropsychologia"},{"key":"ref26","doi-asserted-by":"publisher","first-page":"169","DOI":"10.1159\/000445296","article-title":"High-frequency repetitive transcranial magnetic stimulation can improve depression in Parkinson's disease: a randomized, double-blind, placebo-controlled study","volume":"73","author":"Makkos","year":"2016","journal-title":"Neuropsychobiology"},{"key":"ref27","doi-asserted-by":"publisher","first-page":"884","DOI":"10.1016\/j.brs.2013.05.002","article-title":"High-frequency repetitive transcranial magnetic stimulation over the primary foot motor area in Parkinson's disease","volume":"6","author":"Maruo","year":"2013","journal-title":"Brain Stimul."},{"key":"ref28","doi-asserted-by":"publisher","first-page":"697","DOI":"10.1016\/S1474-4422(19)30044-4","article-title":"Gait impairments in Parkinson's disease","volume":"18","author":"Mirelman","year":"2019","journal-title":"Lancet Neurol."},{"key":"ref29","doi-asserted-by":"publisher","first-page":"2472","DOI":"10.1038\/s41598-021-81795-3","article-title":"Concomitant improvement in anti-saccade success rate and postural instability gait difficulty after rTMS treatment for Parkinson\u2019s disease","volume":"11","author":"Okada","year":"2021","journal-title":"Sci. Rep."},{"key":"ref30","doi-asserted-by":"publisher","first-page":"2311","DOI":"10.1002\/mds.23270","article-title":"The impact of left prefrontal repetitive transcranial magnetic stimulation on depression in Parkinson's disease: a randomized, double\u2010blind, placebo\u2010controlled study","volume":"25","author":"Pal","year":"2010","journal-title":"Mov. Disord."},{"key":"ref31","doi-asserted-by":"publisher","first-page":"79","DOI":"10.1016\/j.nbd.2011.01.032","article-title":"Saccadic latency in Parkinson's disease correlates with executive function and brain atrophy, but not motor severity","volume":"43","author":"Perneczky","year":"2011","journal-title":"Neurobiol. Dis."},{"key":"ref32","doi-asserted-by":"publisher","first-page":"38","DOI":"10.3390\/vision7020038","article-title":"Eye movement latency coefficient of variation as a predictor of cognitive impairment: an eye tracking study of cognitive impairment","volume":"7","author":"Polden","year":"2023","journal-title":"Vision"},{"key":"ref33","doi-asserted-by":"publisher","first-page":"1091","DOI":"10.1016\/bs.irn.2017.05.009","article-title":"Noninvasive brain stimulation and implications for nonmotor symptoms in Parkinson's disease","volume":"134","author":"Rektorov\u00e1","year":"2017","journal-title":"Int. Rev. Neurobiol."},{"key":"ref34","doi-asserted-by":"publisher","first-page":"1093","DOI":"10.1007\/s00702-009-0259-0","article-title":"Effect of high frequency repetitive transcranial magnetic stimulation on reaction time, clinical features and cognitive functions in patients with Parkinson\u2019s disease","volume":"116","author":"Sedl\u00e1\u010dkov\u00e1","year":"2009","journal-title":"J. Neural Transm."},{"key":"ref35","doi-asserted-by":"publisher","first-page":"2609","DOI":"10.1093\/brain\/awg268","article-title":"Striatal dopamine release induced by repetitive transcranial magnetic stimulation of the human motor cortex","volume":"126","author":"Strafella","year":"2003","journal-title":"Brain"},{"key":"ref36","doi-asserted-by":"publisher","first-page":"1690","DOI":"10.1002\/mds.27813","article-title":"Pro\u2010saccades predict cognitive decline in Parkinson\u2019s disease: ICICLE\u2010PD","volume":"34","author":"Stuart","year":"2019","journal-title":"Mov. Disord."},{"key":"ref37","doi-asserted-by":"publisher","first-page":"1697","DOI":"10.1007\/s10072-020-04310-y","article-title":"Eye tracking metrics to screen and assess cognitive impairment in patients with neurological disorders","volume":"41","author":"Tao","year":"2020","journal-title":"Neurol. Sci."},{"key":"ref38","doi-asserted-by":"publisher","first-page":"2745","DOI":"10.1007\/s00415-015-7910-5","article-title":"Antisaccade errors reveal cognitive control deficits in Parkinson\u2019s disease with freezing of gait","volume":"262","author":"Walton","year":"2015","journal-title":"J. Neurol."},{"key":"ref39","doi-asserted-by":"publisher","first-page":"2987","DOI":"10.1007\/s40520-023-02595-5","article-title":"Differential eye movement features between Alzheimer\u2019s disease patients with and without depressive symptoms","volume":"35","author":"Weng","year":"2023","journal-title":"Aging Clin. Exp. Res."},{"key":"ref40","doi-asserted-by":"publisher","first-page":"5389","DOI":"10.18632\/aging.102118","article-title":"Abnormalities of saccadic eye movements in dementia due to Alzheimer\u2019s disease and mild cognitive impairment","volume":"11","author":"Wilcockson","year":"2019","journal-title":"Aging"},{"key":"ref41","doi-asserted-by":"publisher","first-page":"226","DOI":"10.1016\/j.nbd.2015.06.014","article-title":"Motor automaticity in Parkinson's disease","volume":"82","author":"Wu","year":"2015","journal-title":"Neurobiol. Dis."},{"key":"ref42","doi-asserted-by":"publisher","first-page":"72","DOI":"10.1016\/j.jocn.2017.09.023","article-title":"The optimal stimulation site for high-frequency repetitive transcranial magnetic stimulation in Parkinson's disease: a double-blind crossover pilot study[J]","volume":"47","author":"Yokoe","year":"2018","journal-title":"J. Clin. Neurosci."},{"key":"ref43","doi-asserted-by":"publisher","first-page":"750","DOI":"10.1002\/mds.26206","article-title":"Repetitive transcranial magnetic stimulation of the primary motor cortex in the treatment of motor signs in Parkinson's disease: a quantitative review of the literature","volume":"30","author":"Zanjani","year":"2015","journal-title":"Mov. Disord."},{"key":"ref44","doi-asserted-by":"publisher","first-page":"876","DOI":"10.1001\/jamaneurol.2018.0809","article-title":"Using smartphones and machine learning to quantify Parkinson disease severity","volume":"75","author":"Zhan","year":"2018","journal-title":"JAMA Neurol."}],"container-title":["Frontiers in Aging Neuroscience"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fnagi.2024.1480171\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,10,16]],"date-time":"2024-10-16T05:30:45Z","timestamp":1729056645000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fnagi.2024.1480171\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,10,16]]},"references-count":44,"alternative-id":["10.3389\/fnagi.2024.1480171"],"URL":"https:\/\/doi.org\/10.3389\/fnagi.2024.1480171","relation":{},"ISSN":["1663-4365"],"issn-type":[{"value":"1663-4365","type":"electronic"}],"subject":[],"published":{"date-parts":[[2024,10,16]]},"article-number":"1480171"}}