Postural instability and gait are associated with severity and prognosis of Parkinson disease

Heeden, Jorine F. van der; Marinus, Johan; Martinez‐Martín, Pablo; Rodríguez‐Blázquez, Carmen; Geraedts, Victor J.; Hilten, Jacobus J. van

doi:10.1212/wnl.0000000000002768

Cited by 79 publications

(55 citation statements)

References 29 publications

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“…According to this concept, advPD correlates with the implication of neocortical structures implying cognitive impairment. Interestingly and in accordance with the concept of a pathophysiological process affecting dopaminergic and non-dopaminergic structures, patients with a faster disease progression towards advPD present with earlier cognitive impairment and postural instability (Van Der Heeden et al 2016). …”

Section: Strategies To Define Diseases Stagesmentioning

confidence: 64%

Classification of advanced stages of Parkinson’s disease: translation into stratified treatments

Krüger

Klucken²,

Weiß

et al. 2017

J Neural Transm

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Advanced stages of Parkinson’s disease (advPD) still impose a challenge in terms of classification and related stage-adapted treatment recommendations. Previous concepts that define advPD by certain milestones of motor disability apparently fall short in addressing the increasingly recognized complexity of motor and non-motor symptoms and do not allow to account for the clinical heterogeneity that require more personalized approaches. Therefore, deep phenotyping approaches are required to characterize the broad-scaled, continuous and multidimensional spectrum of disease-related motor and non-motor symptoms and their progression under real-life conditions. This will also facilitate the reasoning for clinical care and therapeutic decisions, as neurologists currently have to refer to clinical trials that provide guidance on a group level; however, this does not always account for the individual needs of patients. Here, we provide an overview on different classifications for advPD that translate into critical phenotypic patterns requiring the differential therapeutic adjustments. New concepts refer to precision medicine approaches also in PD and first studies on genetic stratification for therapeutic outcomes provide a potential for more objective treatment recommendations. We define novel treatment targets that align with this concept and make use of emerging device-based assessments of real-life information on PD symptoms. As these approaches require empowerment of patients and integration into treatment decisions, we present communication strategies and decision support based on new technologies to adjust treatment of advPD according to patient demands and safety.

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Section: Strategies To Define Diseases Stagesmentioning

confidence: 64%

Classification of advanced stages of Parkinson’s disease: translation into stratified treatments

Krüger

Klucken²,

Weiß

et al. 2017

J Neural Transm

View full text Add to dashboard Cite

show abstract

“…Median HY was two, with an interquartile range of two to three (limits: 1-5). One-hundred and fifty-one patients (50.3%) had postural instability and gait difficulty PD subtype; 93 (31.0%) showed tremor predominant subtype; and 56 (18.7%) were indeterminate (38,39). Other descriptive data of the sample are displayed in Table 1.…”

Section: Resultsmentioning

confidence: 99%

Relationship of Nocturnal Sleep Dysfunction and Pain Subtypes in Parkinson's Disease

Martinez‐Martín

Rizos

Wetmore

et al. 2018

Movement Disord Clin Pract

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Background Little research has been conducted regarding the relationship between sleep disorders and different pain types in Parkinson's disease (PD). Objective To explore the influence of the various pain subtypes experienced by PD patients on sleep. Methods Three hundred consecutive PD patients were assessed with the PD Sleep Scale‐Version 2 (PDSS‐2), King's PD Pain Scale (KPPS), King's PD Pain Questionnaire (KPPQ), Visual Analog Scales for Pain (VAS‐Pain), and Hospital Anxiety and Depression Scale. Results According to the PDSS‐2, 99.3% of our sample suffered from at least one sleep issue. Those who reported experiencing any modality of pain suffered significantly more from sleep disorders than those who did not (all, P < 0.003). The PDSS‐2 showed moderate‐to‐high correlations with the KPPS (rS = 0.57), KPPQ (0.57), and VAS‐Pain (0.35). When PDSS‐2 items 10 to 12 (pain‐related) were excluded, the correlation values decreased to 0.50, 0.51, and 0.28, respectively, while these items showed moderate‐to‐high correlations with KPPS (0.56), KPPQ (0.54), and VAS‐Pain (0.42). Among the variables analyzed, multiple linear regression models suggested that KPPS and KPPQ were the most relevant predictors of sleep disorders (as per the PDSS‐2), although following exclusion of PDSS‐2 pain items, depression was the relevant predictor. Depression and anxiety were the most relevant predictors in the analysis involving the VAS‐Pain. Regression analysis, considering only the KPPS domains, showed that nocturnal and musculoskeletal pains were the best predictors of overall nocturnal sleep disorder. Conclusions Pain showed a moderate association with nocturnal sleep dysfunction in PD. Some pain subtypes had a greater effect on sleep than others.

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“…Even though non-tremor dominant subtype was also associated with FOG as well as postural instability 33 , akinetic-rigid subtype was predictor for falling into non-forward directions, not falling forward, in our study. Non-tremor dominant subtype is related with more severe and progressive PD 34 , and both FOG and postural instability are common in advanced PD patients. Therefore, relationship among these variables should be interpreted cautiously.…”

Section: Discussionmentioning

confidence: 99%

Falling Direction can Predict the Mechanism of Recurrent Falls in Advanced Parkinson’s Disease

Youn

Okuma

Hwang

et al. 2017

Sci Rep

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Falls are a common and disabling symptom in patients with Parkinson’s disease (PD). For prevention, it is important to understand the pathophysiology of falls in PD patients, but the predictors for the possible mechanisms underlying such falls have not been clearly elucidated. In this prospective observational study, we investigated the implications of falling direction to predict the mechanisms of recurrent falls in PD patients. We enrolled 62 recurrent fallers with PD and divided them into two groups according to the main falling directions: 45 PD fallers who fell forward (forward fallers), and 17 PD fallers who fell in the other directions (non-forward fallers). Although there was no difference in demographic data, parkinsonism, or frontal lobe function, forward fallers showed more severe falls and tended to fall during walking or turning, while non-forward fallers usually fell during sitting/standing or turning. Additionally, forward fallers revealed higher score on a freezing of gait (FOG) questionnaire. Logistic regression analysis demonstrated that FOG was associated with falling forward, while balance impairment, akinetic-rigid subtype, and neuropsychiatric symptoms were associated with falling into the other directions. Our results indicate that FOG and balance impairment are two major mechanisms for recurrent falling in PD patients, and falling direction is an important predictor for these mechanisms.

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Postural instability and gait are associated with severity and prognosis of Parkinson disease

Cited by 79 publications

References 29 publications

Classification of advanced stages of Parkinson’s disease: translation into stratified treatments

Classification of advanced stages of Parkinson’s disease: translation into stratified treatments

Relationship of Nocturnal Sleep Dysfunction and Pain Subtypes in Parkinson's Disease

Falling Direction can Predict the Mechanism of Recurrent Falls in Advanced Parkinson’s Disease

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