Clinical Factors Associated with Abnormal Postures in Parkinson's Disease

<div><p>Background</p><p>Abnormal posture (AP) is often seen in Parkinson's disease (PD), and marked forms known as dropped head syndrome and camptocormia encumber daily living activities. Unlike other motor disabilities such as bradykinesia or muscular rigidity, AP is not always improved but rather deteriorated by PD medication.</p><p>Purpose</p><p>To clarify factors associated with neck and thoracolumbar AP.</p><p>Methods</p><p>Neck flexion (NF) and thoracolumbar (TL) angles were measured in 216 consecutive PD patients and 175 elderly healthy controls. The differences in NF and TL angles between PD patients and controls were designated as ΔNFA and ΔTLA, respectively. The association of ΔNFA or ΔTLA and predictable factors such as age, sex, duration of PD, Hoehn Yahr (H–Y) stage, Unified Parkinson's Disease Rating Scale Part 3 (UPDRS-3), daily dose of dopamine agonists, and comorbid orthopedic spinal lesions was investigated in PD patients. Patients were divided into quartiles according to ΔNFA or ΔTLA. The association between predictable factors and ΔNFA or ΔTLA was estimated as odds ratio (OR), comparing with the lowest quartile as the reference by multivariate regression analysis.</p><p>Results</p><p>Compared with controls, distributions of all three posture angles were significantly shifted rightward in PD patients. Although there were no difference in UPDRS-3 scores in the quartiles of ΔNFA, the highest quartile was associated with H–Y stage ≥3 [OR 2.99, 95% confidence interval (CI) 1.33–6.70, p = 0.008] after adjustment for age, sex and comorbid orthopedic spinal lesions. The highest quartile of ΔTLA was associated with comorbid orthopedic spinal lesions [OR 5.83 (1.42–23.8), p = 0.014], and UPDRS-3 score [OR 3.04 (1.80–5.15)/10 points, p<0.0001].</p><p>Conclusion</p><p>Thoraco-lumbar AP was associated with UPDRS-3 scores and orthopedic spinal lesions, and in contrast, neck AP was not associated with these factors, suggesting that they had different pathomechanisms.</p></div

Demographic data by quartiles of neck-flexion angle.

<p><i>p</i> was calculated by ANOVA(scale variables) or by Pearson Chi square test (categorical variables).</p

Surveyed posture angles in healthy controls (n = 175) and patients with PD (n = 216).

<p>NF angle and FB angle were distributed in a bell shape. They were shifted rightward in PD patients compared with healthy controls.</p

Odds ratios of factors for quartiles of neck flexion angle.

<p>predictable variables: forced entry (age, sex, and orthopedic lesions), forward stepwise likelihood ratio test (duration of PD, H-Y, history of psychosis, history of agonist-related AP, UPDRS-3, Dopa dose, DA agonist dose, amantadine use, selegiline use, and rehabilitation).</p

Diagnostic Accuracy of Apparent Diffusion Coefficient and ¹²³I-Metaiodobenzylguanidine for Differentiation of Multiple System Atrophy and Parkinson’s Disease

<div><p>Background</p><p>It is often hard to differentiate Parkinson’s disease (PD) and parkinsonian variant of multiple system atrophy (MSA-P), especially in the early stages. Cardiac sympathetic denervation and putaminal rarefaction are specific findings for PD and MSA-P, respectively.</p><p>Purpose</p><p>We investigated diagnostic accuracy of putaminal apparent diffusion coefficient (ADC) test for MSA-P and ¹²³I-metaiodobenzylguanidine (MIBG) scintigram for PD, especially in early-stage patients.</p><p>Methods</p><p>The referral standard diagnosis of PD and MSA-P were the diagnostic criteria of the United Kingdom Parkinson’s Disease Society Brain Bank Criteria and the second consensus criteria, respectively. Based on the referral standard criteria, diagnostic accuracy [area under the receiver-operator characteristic curve (AUC), sensitivity and specificity] of the ADC and MIBG tests was estimated retrospectively. Diagnostic accuracy of these tests performed within 3 years of symptom onset was also investigated.</p><p>Results</p><p>ADC and MIBG tests were performed on 138 patients (20 MSA and 118 PD). AUC was 0.95 and 0.83 for the ADC and MIBG tests, respectively. Sensitivity and specificity were 85.0% and 89.0% for MSA-P diagnosis by ADC test and 67.0% and 80.0% for PD diagnosis by MIBG test. When these tests were restricted to patients with disease duration ≤3 years, the sensitivity and specificity were 75.0% and 91.4% for the ADC test (MSA-P diagnosis) and 47.7% and 92.3% for the MIBG test (PD diagnosis).</p><p>Conclusions</p><p>Both tests were useful in differentiating between PD and MSA-P, even in the early stages. In early-stage patients, elevated putaminal ADC was a diagnostic marker for MSA-P. Despite high specificity of the MIBG test, careful neurological history and examinations were required for PD diagnosis because of possible false-negative results.</p></div

Differentiation of MSA-P and PD.

<p>ROC curves of the diagnosing MSA-P by the ADC test (a) and the diagnosing PD by the MIBG test (b). The most discriminative cut-off points (near the left upper corner of the graph) were marked with arrows. The sensitivity and specificity were determined according to the ROC curves.</p

Flow diagram of the eligible patients and the enrollment process of the study.

<p>Eligible patients were 260 consecutive patients who underwent both ADC test and MIBG scintigraphy because of extrapyramidal signs. According to the UK Brain Bank criteria of Parkinson’s Disease and the second consensus statement on the diagnosis of MSA as a reference standard, 153 patients had PD, 24 had MSA-P, and the remaining 83 patients had another condition. Of the 153 patients with PD, 35 with a history of diabetes mellitus (<i>n</i> = 8) and current use of selegiline (<i>n</i> = 26) or droxidopa (<i>n</i> = 3) were excluded. Four patients with MSA-P were excluded (two with diabetes mellitus and two for use of selegiline). ADC and MIBG tests were performed in a total of 138 patients.</p

Demographic and clinical data of the study participants.

<p>Demographic and clinical data of the study participants.</p

Comparison of the putaminal diffusivity (×10^–3 mm²/s) between PD and MSA-P groups.

<p>Comparison of the putaminal diffusivity (×10^–3 mm²/s) between PD and MSA-P groups.</p

data set

data se