BackgroundThe severity of Parkinson’s disease (PD) is difficult to assess objectively owing to the lack of a robust biological marker of underlying disease status, with consequent implications for diagnosis, treatment and prognosis. The current standard tool is the Unified Parkinson’s Disease Rating Scale (MDS-UPDRS), but this is hampered by variability between observers and within subjects. Postural sway has been shown to correlate with complex brain functioning in other conditions. This study aimed to investigate the relationship between postural sway, MDS-UPDRS and other non-motor measures of disease severity in patients with PD.Method25 patients with PD and 18 age-matched controls participated in the study. All participants underwent assessment of postural sway using a force plate, with eyes open and closed. In addition, participants underwent tests of cognition and quality of life: Montreal Cognitive Assessment (MoCA), Neuropsychiatry Unit Cognitive Assessment (NUCOG) and, for the patients, the Parkinson’s Disease Questionnaire (PDQ-39–1), and assessment of clinical status using the motor component of the MDS-UPDRS.ResultsPatients swayed significantly more than controls. This was most obvious in the eyes-closed condition. Sway path length showed strong correlations with PDQ-39–1, MoCA and the verbal fluency component of the NUCOG, and, to a lesser degree, with the UPDRS-III in patients with PD.ConclusionThese results suggest that motor and non-motor symptoms of PD are associated in patients, and, in particular, that postural sway shows potential as a possible measure of underlying disease status in PD, either alone or in combination with other measures.
IntroductionThe severity of Parkinson’s disease (PD) is difficult to assess accurately owing to the lack of a robust biological marker of disease progression, with consequent implications for prognosis and treatment. The current standard measure is the Unified Parkinson’s Disease Rating Scale (UPDRS) but this is hampered by considerable variability between observers and within subjects. Postural sway correlates well with complex brain functioning in other conditions. This study aimed to investigate the correlation of postural sway with the UPDRS and other non-motor measures of disease severity in patients with PD.Methods28 patients with PD (mean age 68 years, range 54–91; 18 male) underwent tests of cognition and quality of life [Montreal Cognitive Assessment (MoCA), Neuropsychiatry Unit Cognitive Assessment (NUCOG) and Parkinson’s Diseases Questionnaire (PDQ-39–1)], assessment of postural sway using a force plate, and assessment of clinical status using the motor component of the UPDRS.ResultsSway path length showed strong correlations with PDQ-39–1, MoCA and the verbal fluency component of the NUCOG (r=0.63,–0.75 and −0.57, respectively; p=0.002,<0.001 and 0.002, respectively) and, to a lesser degree, with the UPDRS III (r=0.45, p=0.018).ConclusionPostural sway shows potential as a sensitive measure of disease severity and brain function in PD, either alone or in combination with other measures. It appears to correlate better with measures of cognition, both general and executive (verbal fluency), and the PDQ measure of disease severity than with the motor component of the UPDRS.
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