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Differentiating Parkinson Disease Subtypes Using Clinical Balance Measures.
J Neurol Phys Ther. 2020 01; 44(1):34-41.JN

Abstract

BACKGROUND AND PURPOSE

People with Parkinson disease (PD) present phenotypes that are characterized as tremor-dominant (TD) or postural instability/gait difficulty (PIGD) subtypes. Differentiation of subtypes allows clinicians to predict disease course and adjust treatment. We examined whether brief mobility and balance measures can discriminate PIGD from TD phenotypes.

METHODS

We performed a cross-sectional study with individuals with PD (n = 104). Blinded raters assessed participants with the Unified Parkinson's Disease Rating Scale (UPDRS) or Movement Disorders Society revision (MDS-UPDRS), and balance assessments: 360° turn test, one-leg stance, a reactive postural control test, and tandem walk. Participants were classified as PIGD or TD based on the UPDRS or MDS-UPDRS assessment results. Differences in balance variables between subtypes were assessed with univariate analyses. Receiver operating characteristic (ROC) curve analyses were performed to investigate the ability of balance variables to differentiate PD subtypes.

RESULTS

No differences between subtypes were observed for tandem walk or reactive postural control. Participants with PIGD performed worse on number of steps and time to complete the 360° turn test and on one-leg stance time. ROC curves showed only the 360° turn test discriminated PIGD from TD with high specificity (0.84). Post hoc analyses revealed that the 360° turn test is the most discriminatory for classifying PD subtypes in early stages of the disease. ROC analyses based on combined models including both the 360° test and tandem walk test performance increased the specificity to 0.97.

DISCUSSION AND CONCLUSIONS

The 360° turn test requires minimal time to administer and may be useful in mild-moderate PD for distinguishing PIGD from TD subtypes.Video Abstract available for more insights from the authors (see the Video, Supplemental Digital Content 1, available at: http://links.lww.com/JNPT/A295).

Authors+Show Affiliations

Faculty of Biology, University of Toulouse III-Paul Sabatier, Toulouse, France (M.P.); Department of Biomedical Engineering, Emory University and the Georgia Institute of Technology, Atlanta, Georgia (J.L.M.); Division of General Medicine and Geriatrics, Department of Medicine, Emory School of Medicine, Atlanta, Georgia (M.P., A.A.B., A.R.H., C.K., A.A., M.E.H.); Department of Kinesiology, University of Georgia, Athens (A.A.); Atlanta VA Center for Visual and Neurocognitive Rehabilitation, Decatur, Georgia (M.E.H.); and Department of Rehabilitation Medicine, Emory School of Medicine, Atlanta, Georgia (M.E.H.).No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Research Support, N.I.H., Extramural
Research Support, U.S. Gov't, Non-P.H.S.

Language

eng

PubMed ID

31834219

Citation

Prime, Morgane, et al. "Differentiating Parkinson Disease Subtypes Using Clinical Balance Measures." Journal of Neurologic Physical Therapy : JNPT, vol. 44, no. 1, 2020, pp. 34-41.
Prime M, McKay JL, Bay AA, et al. Differentiating Parkinson Disease Subtypes Using Clinical Balance Measures. J Neurol Phys Ther. 2020;44(1):34-41.
Prime, M., McKay, J. L., Bay, A. A., Hart, A. R., Kim, C., Abraham, A., & Hackney, M. E. (2020). Differentiating Parkinson Disease Subtypes Using Clinical Balance Measures. Journal of Neurologic Physical Therapy : JNPT, 44(1), 34-41. https://doi.org/10.1097/NPT.0000000000000297
Prime M, et al. Differentiating Parkinson Disease Subtypes Using Clinical Balance Measures. J Neurol Phys Ther. 2020;44(1):34-41. PubMed PMID: 31834219.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Differentiating Parkinson Disease Subtypes Using Clinical Balance Measures. AU - Prime,Morgane, AU - McKay,J Lucas, AU - Bay,Allison A, AU - Hart,Ariel R, AU - Kim,Chaejin, AU - Abraham,Amit, AU - Hackney,Madeleine E, PY - 2019/12/14/entrez PY - 2019/12/14/pubmed PY - 2021/1/5/medline SP - 34 EP - 41 JF - Journal of neurologic physical therapy : JNPT JO - J Neurol Phys Ther VL - 44 IS - 1 N2 - BACKGROUND AND PURPOSE: People with Parkinson disease (PD) present phenotypes that are characterized as tremor-dominant (TD) or postural instability/gait difficulty (PIGD) subtypes. Differentiation of subtypes allows clinicians to predict disease course and adjust treatment. We examined whether brief mobility and balance measures can discriminate PIGD from TD phenotypes. METHODS: We performed a cross-sectional study with individuals with PD (n = 104). Blinded raters assessed participants with the Unified Parkinson's Disease Rating Scale (UPDRS) or Movement Disorders Society revision (MDS-UPDRS), and balance assessments: 360° turn test, one-leg stance, a reactive postural control test, and tandem walk. Participants were classified as PIGD or TD based on the UPDRS or MDS-UPDRS assessment results. Differences in balance variables between subtypes were assessed with univariate analyses. Receiver operating characteristic (ROC) curve analyses were performed to investigate the ability of balance variables to differentiate PD subtypes. RESULTS: No differences between subtypes were observed for tandem walk or reactive postural control. Participants with PIGD performed worse on number of steps and time to complete the 360° turn test and on one-leg stance time. ROC curves showed only the 360° turn test discriminated PIGD from TD with high specificity (0.84). Post hoc analyses revealed that the 360° turn test is the most discriminatory for classifying PD subtypes in early stages of the disease. ROC analyses based on combined models including both the 360° test and tandem walk test performance increased the specificity to 0.97. DISCUSSION AND CONCLUSIONS: The 360° turn test requires minimal time to administer and may be useful in mild-moderate PD for distinguishing PIGD from TD subtypes.Video Abstract available for more insights from the authors (see the Video, Supplemental Digital Content 1, available at: http://links.lww.com/JNPT/A295). SN - 1557-0584 UR - https://www.unboundmedicine.com/medline/citation/31834219/Differentiating_Parkinson_Disease_Subtypes_Using_Clinical_Balance_Measures_ L2 - https://doi.org/10.1097/NPT.0000000000000297 DB - PRIME DP - Unbound Medicine ER -