Clinical Definition of Camptocormia in Parkinson's Disease

Abstract

Background Clinical key aspects of camptocormia in patients with idiopathic Parkinson's disease (PD) await further definition. Methods Based on a self‐assessment of PD patients, we performed an observational study, asking patients with subjectively felt involuntary forward bending to return a questionnaire and provide photographs showing their axial disorder. Forty‐two matched PD patients without subjective signs of camptocormia were recruited as controls. Results The stooped posture of patients with advanced PD without camptocormia is characterized by a forward bending angle of always less than 30 degrees. Of the 145 camptocormia patients in our study, 70% had an angle ≥30 degrees. The patients with a more‐severe forward bending angle were more severely affected in daily life than those with an angle of less than 30 degrees. Back pain was more frequent (81% vs. 43%) and more severe in PD patients with camptocormia than in controls. Back diseases in camptocormia PD patients were also significantly more frequent than in the PD control patients (55% vs. 26%). Camptocormia is a relevant burden in everyday life. Seventy‐seven percent of patients needed walking aids and 85% reported specific disabilities attributed to camptocormia (e.g. increased risk of falling, dyspnea, problems in eating or swallowing). Conclusions Camptocormia cannot be clinically defined based on the forward bending angle alone, but an angle larger than 30 degrees is only found in camptocormia. Back pain is an essential aspect of camptocormia in PD. Back diseases can be seen as a risk factor in these patients.

Diagnostic criteria for camptocormia in Parkinson's disease: A consensus-based proposal

“…Our results are in line with the findings reported by Margraf and collaborators [26]. In fact, 90% of their camptocormia patients needed walking aids and 93% reported specific disabilities attributed to camptocormia [26].…”

“…Our results are in line with the findings reported by Margraf and collaborators [26]. In fact, 90% of their camptocormia patients needed walking aids and 93% reported specific disabilities attributed to camptocormia [26]. Since patients with bending angles greater than 30° were more severely affected in ADLs, the authors identified this angle as their diagnostic cut-off [26].…”

Does the Degree of Trunk Bending Predict Patient Disability, Motor Impairment, Falls, and Back Pain in Parkinson's Disease?

“…With regard to limitations in ADLs and perceived pain, a study uncorrected for possible confounders involving 145 subjects with PD and FTB did not yield convincing evidence for a threshold angle defining CC (27). Indeed, while showing a significant association between FTB ≥30 • and limitations in ADLs and back pain, the authors remarked that less severe forward angles do not exclude CC (27). They found greater limitations in ADLs in patients with FTB ≥30 • , which is in line with our univariate regression models reported for upper FTB.…”

“…Our data are consistent with previous studies indicating that the association between postural abnormalities and such variables may be more closely related to the severity of the PD phenotype and disease progression than to the severity of trunk flexion itself (1, 5). With regard to limitations in ADLs and perceived pain, a study uncorrected for possible confounders involving 145 subjects with PD and FTB did not yield convincing evidence for a threshold angle defining CC (27). Indeed, while showing a significant association between FTB ≥30 • and limitations in ADLs and back pain, the authors remarked that less severe forward angles do not exclude CC (27).…”

Síndrome de la espalda inclinada. Presentación de cuatro casos y revisión de la bibliografía. [Bent spine syndrome. Presentation of four cases and literature review]

“…10 En algunos casos, es indoloro, aunque en la mayoría, se asocia con dolor lumbar axial, sobre todo cuando se asocia con la enfermedad de Parkinson. [11][12][13] El SEI difícilmente se confunde con el "síndrome de la cabeza caída" (dropped head syndrome), aunque ambos cuadros comparten muchas de las causas que los originan, se presentan juntos en muy raras ocasiones. 14 Se estima que la edad media de presentación clínica del SEI es de 65 años, el 69% de los pacientes tiene antecedentes de enfermedad de Parkinson y el 25%, de distonía.…”