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Axial motor clues to identify atypical parkinsonism: A multicentre European cohort study

2018; Elsevier BV; Volume: 56; Linguagem: Inglês

10.1016/j.parkreldis.2018.06.015

1873-5126

Carlijn D.J.M. Borm, Florian Krismer, Gregor K. Wenning, Klaus Seppi, Werner Poewe, Maria Teresa Pellecchia, Paolo Barone, Erik Johnsen, Karen Østergaard, Tanya Gurevich, Ruth Djaldetti, Luisa Sambati, Pietro Cortelli, Igor Petrović, Vladimir Kostić, Hana Brožová, Evžen Růžička, Marı́a José Martı́, Eduardo Tolosa, Margherita Canesi, Bart Post, Jorik Nonnekes, Bastiaan R. Bloem, Karen Østergaard, María Stamelou, Eduardo Tolosa, Vladimir Kostić, Pietro Cortelli, Thomas Klockgether, Richard Dodel, Michael Abele, Wassilios G. Meissner, Heinz Reichmann, Tim Lynch, Jarosław Sławek, Werner Poewe, Gregor K. Wenning, Mag Klaus Seppi, Florian Krismer, Daniela Berg, Joaquim J. Ferreira, Henry Houlden, Niall Quinn, Håkan Widner, Alexander Gerhard, Karla Eggert, Alberto Albanese, Francesca Del Sorbo, Paolo Barone, Maria Teresa Pellecchia, Bas R. Bloem, Carlijn D.J.M. Borm, Ruth Djaldetti, Alfredo Berardelli, Carlo Colosimo, José Berciano, Latchezar Traykov, Nir Giladi, Tanya Gurevich, Olivier Rascol, Monique Galitzky, Thomas Gasser,

Neurological disorders and treatments

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.