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Methods and utility of quantitative brainstem measurements in progressive supranuclear palsy versus Parkinson's disease in a routine clinical setting.

ABSTRACT:

Background and purpose

The clinical diagnosis of progressive supranuclear palsy can be challenging, as the clinical presentation overlaps with that of Parkinson's disease and multiple system atrophy. We sought to examine the practical utility of radiologic markers of progressive supranuclear palsy by investigating whether these markers could distinguish between patients with progressive supranuclear palsy-Richardson syndrome (PSP-RS) and those with Parkinson's disease based on imaging obtained in a typical clinical setting, not in a prospective research environment.

Materials and methods

This retrospective study included 13 patients with PSP-RS and 13 patients with Parkinson's disease who were followed for either condition at our institution at the time of the study and who had MRI records available. Patients were selected without regard to type of imaging obtained. All diagnoses were confirmed by a trained movement disorders specialist using validated diagnostic criteria. Groups were matched for age and disease duration at the time of scanning. MRI records were retrospectively obtained, and image analysis was performed by investigators blinded to disease classification. Midbrain area, midbrain to pons area ratio, midbrain anterior-posterior diameter, and MR parkinsonism index were calculated for each patient.

Results

All established measures of identifying progressive supranuclear palsy (midbrain area, midbrain to pons area ratio, midbrain anterior-posterior diameter, and MR parkinsonism index) were significantly different between patients with PSP-RS and those with Parkinson's disease.

Conclusion

Previously established radiographic markers distinguishing between PSP-RS and Parkinson's disease have practical utility in the clinical setting and not just in well-designed prospective analyses.

SUBMITTER: Cooperrider J

PROVIDER: S-EPMC8298805 | biostudies-literature |

REPOSITORIES: biostudies-literature

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Project description:Repetitive finger tapping is commonly used to assess bradykinesia in Parkinson's disease. The Queen Square Brain Bank diagnostic criterion of Parkinson's disease defines bradykinesia as 'slowness of initiation with progressive reduction in speed and amplitude of repetitive action'. Although progressive supranuclear palsy is considered an atypical parkinsonian syndrome, it is not known whether patients with progressive supranuclear palsy have criteria-defined bradykinesia. This study objectively assessed repetitive finger tap performance and handwriting in patients with Parkinson's disease (n?=?15), progressive supranuclear palsy (n?=?9) and healthy age- and gender-matched controls (n?=?16). The motion of the hand and digits was recorded in 3D during 15-s repetitive index finger-to-thumb tapping trials. The main finding was hypokinesia without decrement in patients with progressive supranuclear palsy, which differed from the finger tap pattern in Parkinson's disease. Average finger separation amplitude in progressive supranuclear palsy was less than half of that in controls and Parkinson's disease (P?<?0.001 in both cases). Change in tap amplitude over consecutive taps was computed by linear regression. The average amplitude slope in progressive supranuclear palsy was nearly zero (0.01°/cycle) indicating a lack of decrement, which differed from the negative slope in patients with Parkinson's disease OFF levodopa (-0.20°/cycle, P?=?0.002). 'Hypokinesia', defined as <50% of control group's mean amplitude, combined with 'absence of decrement', defined as mean positive amplitude slope, were identified in 87% of finger tap trials in the progressive supranuclear palsy group and only 12% in the Parkinson's disease OFF levodopa group. In progressive supranuclear palsy, the mean amplitude was not correlated with disease duration or other clinimetric scores. In Parkinson's disease, finger tap pattern was compatible with criteria-defined bradykinesia, characterized by slowness with progressive reduction in amplitude and speed and increased variability in speed throughout the tap trial. In Parkinson's disease, smaller amplitude, slower speed and greater speed variability were all associated with a more severe Unified Parkinson's Disease Rating Scale motor score. Analyses of handwriting showed that micrographia, defined as smaller than 50% of the control group's mean script size, was present in 75% of patients with progressive supranuclear palsy and 15% of patients with Parkinson's disease (P?=?0.022). Most scripts performed by patients with progressive supranuclear palsy did not exhibit decrements in script size. In conclusion, patients with progressive supranuclear palsy have a specific finger tap pattern of 'hypokinesia without decrement' and they do not have criteria-defined limb bradykinesia. Similarly, 'micrographia' and 'lack of decrement in script size' are also more common in progressive supranuclear palsy than in Parkinson's disease.