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

2016; Lippincott Williams & Wilkins; Volume: 86; Issue: 24 Linguagem: Inglês

10.1212/wnl.0000000000002768

1526-632X

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

Botulinum Toxin and Related Neurological Disorders

Objective: Differences in disease progression in Parkinson disease (PD) have variously been attributed to 2 motor subtypes: tremor-dominant (TD) and postural instability and gait difficulty (PIGD)–dominant (PG). We evaluated the role of these phenotypic variants in severity and progression of nondopaminergic manifestations of PD and motor complications. Methods: Linear mixed models were applied to data from the Profiling Parkinson9s disease (PROPARK) cohort (n = 396) to evaluate the effect of motor subtype on severity and progression of cognitive impairment (Scales for Outcomes in Parkinson9s disease [SCOPA]–Cognition [SCOPA-COG]), depression (Hospital Anxiety and Depression Scale [HADS]), autonomic dysfunction (SCOPA–Autonomic [SCOPA-AUT]), excessive daytime sleepiness, psychotic symptoms (SCOPA–Psychiatric Complications [SCOPA-PC]), and motor complications. In first analyses, subtype as determined by the commonly used ratio of tremor over PIGD score was entered as a factor, whereas in second analyses separate tremor and PIGD scores were used. Results were verified in an independent cohort (Estudio Longitudinal de Pacientes con Enfermedad de Parkinson [ELEP]; n = 365). Results: The first analyses showed that PG subtype patients had worse SCOPA-COG, HADS, SCOPA-AUT, SCOPA-PC, and motor complications scores, and exhibited faster progression on the SCOPA-COG. The second analyses showed that only higher PIGD scores were associated with worse scores for these variables; tremor score was not associated with severity or progression of any symptom. Analyses in the independent cohort yielded similar results. Conclusions: In contrast to PIGD, which consistently was associated with greater severity of nondopaminergic symptoms, there was no evidence of a benign effect of tremor. Our findings do not support the use of the TD subtype as a prognostic trait in PD. The results showed that severity of PIGD is a useful indicator of severity and prognosis in PD by itself.