Introduction The overall frequency of postural abnormalities (PA) in Parkinson's disease (PD) is unknown. We evaluated the overall prevalence of PA and assessed the association with demographic and clinical variables. Methods For this multicenter, cross‐sectional study, consecutive PD outpatients attending 7 tertiary Italian centers were enrolled. Patients were evaluated and compared for the presence of isolated PA such as camptocormia, Pisa syndrome, and anterocollis and for combined forms (ie, camptocormia + Pisa syndrome) together with demographic and clinical variables. Results Of the total 811 PD patients enrolled, 174 (21.5%; 95% confidence interval [CI], 18.6%–24.3%) presented PA, 144 of which had isolated PA and 30 had combined PA. The prevalence of camptocormia was 11.2% (95% CI, 9%–13.3%), Pisa syndrome 8% (95% CI, 6.2%–9.9%), and anterocollis 6.5% (95% CI, 4.9%–8.3%). Patients with PA were more often male and older with longer disease duration, more advanced disease stage, more severe PD symptoms, a bradykinetic/rigid phenotype, and poorer quality of life. They were initially treated with levodopa, and more likely to be treated with a combination of levodopa and dopamine agonist, took a higher daily levodopa equivalent daily dose, and had more comorbidities. Falls and back pain were more frequent in PD patients with PA than in those without PA. Multiple logistic regression models confirmed an association between PA and male gender, older age, Hoehn and Yahr stage, and total Unified Parkinson's Disease Rating Scale score. Conclusions PA are frequent and disabling complications in PD, especially in the advanced disease stages.

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BackgroundPrevious molecular imaging studies comparing dopamine function in vivo between early‐onset PD and late‐onset PD patients have shown contradictory results, presumably attributable to the aging‐related decline in nigrostriatal function.Objectives(1) To investigate baseline dopamine transporter availability in early‐onset PD (<55 years) and late‐onset PD (>70 years) patients, z‐scores values of putamen and caudate [123I]‐ioflupane uptake were calculated using the respective age‐matched controls in order to correct for early presynaptic compensatory mechanisms and age‐related dopamine neuron loss; (2) to examine the associations of such baseline single‐photon emission computed tomography measures with the emergence of late‐disease motor complications.MethodsIn this retrospective study, 105 de novo PD patients who underwent [123I]‐ioflupane single‐photon emission computed tomography at time of diagnosis were divided into three tertile groups according to age at disease onset (35 early‐onset PD and 40 late‐onset PD patients). Z‐scores were compared between the two groups, and their predictive power for motor complications (during a mean follow‐up of 7 years) was evaluated using Cox proportional hazard models.ResultsDespite a less‐severe motor phenotype, early‐onset PD patients exhibited more reduced [123I]‐ioflupane binding in the putamen and had a higher and earlier risk for developing motor complications than those with late‐onset PD. Lower [123I]‐Ioflupane uptake in the putamen and caudate increased the risk of motor complications.ConclusionsOur findings indicate that a lower dopamine transporter binding in early‐onset PD predicts the later development of motor complications, but it is not related to severity of motor symptoms, suggesting age‐related differences in striatal compensatory mechanisms in PD. © 2020 International Parkinson and Movement Disorder Society

Background: Postural abnormalities in Parkinson's disease (PD) form a spectrum of functional trunk misalignment, ranging from a "typical" parkinsonian stooped posture to progressively greater degrees of spine deviation. Objective: To analyze the association between degree of postural abnormalities and disability and to determine cutoff values of trunk bending associated with limitations in activities of daily living (ADLs), motor impairment, falls, and back pain. Methods: The study population was 283 PD patients with ≥5 • of forward trunk bending (FTB), lateral trunk bending (LTB) or forward neck bending (FNB). The degrees were calculated using a wall goniometer (WG) and software-based measurements (SBM). Logistic regression models were used to identify the degree of bending associated with moderate/severe limitation in ADLs (Movement Disorders Society Unified PD Rating Scale [MDS-UPDRS] part II ≥17), moderate/severe motor impairment (MDS-UPDRS part III ≥33), history of falls (≥1), and moderate/severe back pain intensity (numeric rating scale ≥4). The optimal cutoff was identified using receiver operating characteristic (ROC) curves. Results: We found significant associations between modified Hoehn & Yahr stage, disease duration, sex, and limitation in ADLs, motor impairment, back pain intensity, and history of falls. Degree of trunk bending was associated only with motor impairment Geroin et al.

A major goal of current clinical research in Parkinson’s disease (PD) is the validation and standardization of biomarkers enabling early diagnosis, predicting outcomes, understanding PD pathophysiology, and demonstrating target engagement in clinical trials. Molecular imaging with specific dopamine-related tracers offers a practical indirect imaging biomarker of PD, serving as a powerful tool to assess the status of presynaptic nigrostriatal terminals. In this review we provide an update on the dopamine transporter (DAT) imaging in PD and translate recent findings to potentially valuable clinical practice applications. The role of DAT imaging as diagnostic, preclinical and predictive biomarker is discussed, especially in view of recent evidence questioning the incontrovertible correlation between striatal DAT binding and nigral cell or axon counts.