Highlights
- •Postural instability is more common in atypical parkinsonism than Parkinson's disease.
- •Tandem gait performance discriminates between atypical parkinsonism and PD.
- •Combining the tandem gait, TUG-test and retropulsion test could improve sensitivity and speed up clinical examination.
Abstract
Objective
Differentiating Parkinson's disease (PD) from atypical parkinsonian disorders (APD)
such as Multiple System Atrophy, parkinsonian type (MSA-p) or Progressive Supranuclear
Palsy (PSP-RS) can be challenging. Early signs of postural Instability and gait disability
(PIGD) are considered clues that may signal presence of APD. However, it remains unknown
which PIGD test – or combination of tests – can best distinguish PD from APD. We evaluated
the discriminative value of several widely-used PIGD tests, and aimed to develop a
short PIGD evaluation that can discriminate parkinsonian disorders.
Methods
In this multicentre cohort study patients were recruited by 11 European MSA Study
sites. Patients were diagnosed using standardized criteria. Postural instability and
gait disability was evaluated using interviews and several clinical tests.
Results
Nineteen PD, 21 MSA-p and 25 PSP-RS patients were recruited. PIGD was more common
in APD compared to PD. There was no significant difference in axial symptoms between
PSP-RS and MSA-p, except for self-reported falls (more frequent in PSP-RS patients).
The test with the greatest discriminative power to distinguish APD from PD was the
ability to perform tandem gait (AUC 0.83; 95% CI 71–94; p < 0.001), followed by the
retropulsion test (AUC 0.8; 95% CI 0.69–0.91; p < 0.001) and timed-up-and-go test
(TUG) (AUC 0.77; 95% CI 0.64–0.9; p = 0.001). The combination of these three tests
yielded highest diagnostic accuracy (AUC 0.96; 95% CI 0.92–1.0; p < 0.001).
Conclusions
Our study suggests that simple “bedside” PIGD tests – particularly the combination
of tandem gait performance, TUG and retropulsion test – can discriminate APD from
PD.
Keywords
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References
- Idiopathic Parkinson's disease combined with multiple system atrophy.A clinicopathological report, Movement disorders : Official Journal of the Movement Disorder Society. 1991; 6: 342-346
- MDS clinical diagnostic criteria for Parkinson's disease.Mov. Disord. : Official Journal of the Movement Disorder Society. 2015; 30: 1591-1601
- Red flags for multiple system atrophy.Mov. Disord. : Official Journal of the Movement Disorder Society. 2008; 23: 1093-1099
- Reliability of measurements obtained with the timed “up & go” test in people with Parkinson disease.Phys. Ther. 2001; 81: 810-818
- Multiple balance tests improve the assessment of postural stability in subjects with Parkinson's disease.J. Neurol. Neurosurg. Psychiatry. 2006; 77: 322-326
- The retropulsion test: a good evaluation of postural instability in Parkinson's disease?.J. Parkinson's Dis. 2015; 5: 43-47
- Ten steps to identify atypical parkinsonism.J. Neurol. Neurosurg. Psychiatry. 2006; 77: 1367-1369
- Balance confidence and functional mobility are independently associated with falls in people with Parkinson's disease.J. Neurol. 2009; 256: 742-749
- Diagnostic criteria for Parkinson disease.Arch. Neurol. 1999; 56: 33-39
- Consensus statement on the diagnosis of multiple system atrophy.J. Auton. Nerv. Syst. 1998; 74: 189-192
- Clinical research criteria for the diagnosis of progressive supranuclear palsy (Steele-Richardson-Olszewski syndrome): report of the NINDS-SPSP international workshop.Neurology. 1996; 47: 1-9
- Clinicopathological investigation of vascular parkinsonism, including clinical criteria for diagnosis.Mov. Disord. : Official Journal of the Movement Disorder Society. 2004; 19: 630-640
- U.R.T.F. Movement disorder society, movement disorder society-sponsored revision of the unified Parkinson's disease rating scale (MDS-UPDRS): scale presentation and clinimetric testing results.Mov. Disord. : Official Journal of the Movement Disorder Society. 2008; 23: 2129-2170
- Development and validation of the unified multiple system atrophy rating scale (UMSARS).Mov. Disord. : Official Journal of the Movement Disorder Society. 2004; 19: 1391-1402
- A clinical rating scale for progressive supranuclear palsy.Brain : A Journal of Neurology. 2007; 130: 1552-1565
- “Mini-mental state”: a practical method for grading the cognitive state of patients for the clinician.J. Psychiatr. Res. 1975; 12: 189-198
- The “bicycle sign”for atypical parkinsonism.Lancet. 2011; 377: 125-126
- Medio-lateral balance impairment differentiates between Parkinson's disease and atypical parkinsonism.J. Parkinson's Dis. 2014; 4: 567-569
- Prospective assessment of falls in Parkinson's disease.Mov. Disord. : Official Journal of the Movement Disorder Society. 1998; 10: 147
- Parkinsonian single fallers versus recurrent fallers: different fall characteristics and clinical features.J. Neurol. 2010; 257: 1543-1551
- The multiple tasks test.Strategies in Parkinson's Disease, Exp Brain Res. 2001; 137: 478-486
- Ancillary investigations to diagnose parkinsonism: a prospective clinical study.J. Neurol. 2015; 262: 346-356
- A reappraisal of the ten steps test for identifying atypical parkinsonism.Clin. Neurol. Neurosurg. 2014; 119: 1-3
- Gait and balance in basal ganglia disorders.Clinical Disorders of Balance, Posture and Gait. 2004; : 173-206
- Regional brain volumes distinguish PSP, MSA-P, and PD: MRI-based clinico-radiological correlations.Mov. Disord. : Official Journal of the Movement Disorder Society. 2006; 21: 989-996
- Timed up and Go test and risk of falls in older adults: a systematic review.J. Nutr. Health Aging. 2011; 15: 933-938
- Clinical correlates of cerebral white matter abnormalities in patients with Parkinson's disease.Park. Relat. Disord. 2018; 49: 28-33
- Vascular pathology in patients with idiopathic Parkinson's disease.Park. Relat. Disord. 2009; 15: 24-29
- Leucoaraiosis, nigrostriatal denervation and motor symptoms in Parkinson's disease.Brain : A Journal of Neurology. 2011; 134: 2358-2365
- Bicycle sign for differential diagnosis of parkinsonism: is it of use in a hilly country like Japan?.J. Parkinson's Dis. 2011; 1: 167-168
- Forgetting falls. The limited accuracy of recall of falls in the elderly.J. Am. Geriatr. Soc. 1988; 36: 613-616
- Clinimetrics of freezing of gait.Mov. Disord. : Official Journal of the Movement Disorder Society. 2008; 23: S468-S474
- Freezing of gait in Parkinson's disease: the impact of dual-tasking and turning.Mov. Disord. : Official Journal of the Movement Disorder Society. 2010; 25: 2563-2570
- Prospective differentiation of multiple system atrophy from Parkinson disease, with and without autonomic failure.Arch. Neurol. 2009; 66: 742-750
Article info
Publication history
Published online: June 08, 2018
Accepted:
June 7,
2018
Received in revised form:
June 4,
2018
Received:
April 3,
2018
Footnotes
☆Statistical Analysis conducted by Drs. Borm, MD and R. donders PhD, Radboud University Medical centre.
Identification
Copyright
© 2018 Elsevier Ltd. All rights reserved.
