Dataset Information

Differentiating Parkinson Disease Subtypes Using Clinical Balance Measures.

ABSTRACT:

Background and purpose

People with Parkinson disease (PD) present phenotypes that are characterized as tremor-dominant (TD) or postural instability/gait difficulty (PIGD) subtypes. Differentiation of subtypes allows clinicians to predict disease course and adjust treatment. We examined whether brief mobility and balance measures can discriminate PIGD from TD phenotypes.

Methods

We performed a cross-sectional study with individuals with PD (n = 104). Blinded raters assessed participants with the Unified Parkinson's Disease Rating Scale (UPDRS) or Movement Disorders Society revision (MDS-UPDRS), and balance assessments: 360° turn test, one-leg stance, a reactive postural control test, and tandem walk. Participants were classified as PIGD or TD based on the UPDRS or MDS-UPDRS assessment results. Differences in balance variables between subtypes were assessed with univariate analyses. Receiver operating characteristic (ROC) curve analyses were performed to investigate the ability of balance variables to differentiate PD subtypes.

Results

No differences between subtypes were observed for tandem walk or reactive postural control. Participants with PIGD performed worse on number of steps and time to complete the 360° turn test and on one-leg stance time. ROC curves showed only the 360° turn test discriminated PIGD from TD with high specificity (0.84). Post hoc analyses revealed that the 360° turn test is the most discriminatory for classifying PD subtypes in early stages of the disease. ROC analyses based on combined models including both the 360° test and tandem walk test performance increased the specificity to 0.97.

Discussion and conclusions

The 360° turn test requires minimal time to administer and may be useful in mild-moderate PD for distinguishing PIGD from TD subtypes.Video Abstract available for more insights from the authors (see the Video, Supplemental Digital Content 1, available at: http://links.lww.com/JNPT/A295).

SUBMITTER: Prime M

PROVIDER: S-EPMC6991154 | biostudies-literature | 2020 Jan

REPOSITORIES: biostudies-literature

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Publications

Differentiating Parkinson Disease Subtypes Using Clinical Balance Measures.

Prime Morgane M McKay J Lucas JL Bay Allison A AA Hart Ariel R AR Kim Chaejin C Abraham Amit A Hackney Madeleine E ME

Journal of neurologic physical therapy : JNPT 20200101 1

<h4>Background and purpose</h4>People with Parkinson disease (PD) present phenotypes that are characterized as tremor-dominant (TD) or postural instability/gait difficulty (PIGD) subtypes. Differentiation of subtypes allows clinicians to predict disease course and adjust treatment. We examined whether brief mobility and balance measures can discriminate PIGD from TD phenotypes.<h4>Methods</h4>We performed a cross-sectional study with individuals with PD (n = 104). Blinded raters assessed partici ...[more]

PMID: 31834219

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Project description:ImportanceClinical subtyping of Parkinson disease at diagnosis is useful in estimating disease course and survival. Severity and rate of progression of neuropathologies are important determinants of clinical Parkinson subtypes.ObjectiveTo provide longitudinal clinical disease-course data and neuropathologic correlation for newly proposed Parkinson disease subtypes.Design, setting, and participantsRetrospective cohort study of consecutive patients with autopsy-confirmed Parkinson disease who were regularly seen throughout their disease course by hospital specialists in the United Kingdom and donated their brain at death to the Queen Square Brain Bank between January 2009 and December 2017. Patients with additional neuropathologic diagnoses, monogenic forms of parkinsonism, or insufficiently detailed clinical information were excluded. Based on severity of motor symptoms, rapid eye movement sleep behavior disorder, and autonomic and cognitive function at diagnosis, patients were classified adapting a subtyping classification into mild-motor predominant, intermediate, or diffuse malignant subtypes.Main outcomes and measuresTime from diagnosis to disease milestones (recurrent falls, wheelchair dependence, dementia, and care home placement) and death were compared between subtypes, and their risk was estimated using Cox hazard regression models. Severity and distribution of Lewy pathology and Alzheimer disease-related pathology were assessed using staging systems.ResultsFrom a total of 146 patients, 111 patients were included (67 men [60.4%]; mean [SD] age at diagnosis, 62.5 [11.5] years). The diffuse malignant subtype had earlier development of milestones and reduced survival. Cox proportional hazard regression showed an increased adjusted risk of any disease milestone (hazard ratio, 10.90; 95% CI, 5.51-21.58; P < .001) and death (hazard ratio, 3.65; 95% CI, 1.98-6.75; P < .001) in the diffuse malignant group. Age at diagnosis was the only additional variable with statistical significance (adjusted hazard ratio for death, 1.14; 95% CI, 1.11-1.17; P <.001). Staging of Lewy pathology and Alzheimer disease-related pathology did not differ between subtypes, although they showed different rates of progression, and the latter was associated with age at death.Conclusions and relevanceParkinson clinical subtypes at diagnosis may estimate disease course and survival, which may be useful in providing a more accurate prognosis in individual patients in clinical practice and helping to stratify subgroups in clinical trials. Different severity and progression of neuropathologies are important determinants of Parkinson subtypes, and age at diagnosis should be included in future subtype classifications.

Project description:ObjectiveTo assess the effect of exercise training by using the Nintendo Wii Fit video game and balance board system on balance and gait in adults with Parkinson disease (PD).DesignA prospective interventional cohort study.SettingAn outpatient group exercise class.ParticipantsTen subjects with PD, Hoehn and Yahr stages 2.5 or 3, with a mean age of 67.1 years; 4 men, 6 women.InterventionsThe subjects participated in supervised group exercise sessions 3 times per week for 8 weeks by practicing 3 different Wii balance board games (marble tracking, skiing, and bubble rafting) adjusted for their individualized function level. The subjects trained for 10 minutes per game, a total of 30 minutes training per session.Main outcome measurementsPre-and postexercise training, a physical therapist evaluated subjects' function by using the Berg Balance Scale, Dynamic Gait Index, and Sharpened Romberg with eyes open and closed. Postural sway was assessed at rest and with tracking tasks by using the Wii balance board. The subjects rated their confidence in balance by using the Activities-specific Balance Confidence scale and depression on the Geriatric Depression Scale.ResultsBalance as measured by the Berg Balance Scale improved significantly, with an increase of 3.3 points (P = .016). The Dynamic Gait Index improved as well (mean increase, 2.8; P = .004), as did postural sway measured with the balance board (decreased variance in stance with eyes open by 31%; P = .049). Although the Sharpened Romberg with eyes closed increased by 6.85 points and with eyes opened by 3.3 points, improvements neared significance only for eyes closed (P = .07 versus P = .188). There were no significant changes on patient ratings for the Activities-specific Balance Confidence (mean decrease, -1%; P = .922) or the Geriatric Depression Scale (mean increase, 2.2; P = .188).ConclusionsAn 8-week exercise training class by using the Wii Fit balance board improved selective measures of balance and gait in adults with PD. However, no significant changes were seen in mood or confidence regarding balance.

Dataset Information

Differentiating Parkinson Disease Subtypes Using Clinical Balance Measures.

Background and purpose

Methods

Results

Discussion and conclusions

Publications

Differentiating Parkinson Disease Subtypes Using Clinical Balance Measures.

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