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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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.