Impaired Trunk Stability in Individuals at High Risk for Parkinson's Disease

Abstract

BackgroundThe search for disease-modifying treatments for Parkinson's disease advances, however necessary markers for early detection of the disease are still lacking. There is compelling evidence that changes of postural stability occur at very early clinical stages of Parkinson's disease, making it tempting to speculate that changes in sway performance may even occur at a prodromal stage, and may have the potential to serve as a prodromal marker for the disease.Methodology/Principal FindingsBalance performance was tested in 20 individuals with an increased risk of Parkinson's disease, 12 Parkinson's disease patients and 14 controls using a cross-sectional approach. All individuals were 50 years or older. Investigated groups were similar with respect to age, gender, and height. An accelerometer at the centre of mass at the lower spine quantified sway during quiet semitandem stance with eyes open and closed, as well as with and without foam. With increasing task difficulty, individuals with an increased risk of Parkinson's disease showed an increased variability of trunk acceleration and a decrease of smoothness of sway, compared to both other groups. These differences reached significance in the most challenging condition, i.e. the eyes closed with foam condition.Conclusions/SignificanceIndividuals with an increased risk of Parkinson's disease have subtle signs of a balance deficit under most challenging conditions. This preliminary finding should motivate further studies on sway performance in individuals with an increased risk of Parkinson's disease, to evaluate the potential of this symptom to serve as a biological marker for prodromal Parkinson's disease.

Accelerometer-based quantitative analysis of axial nocturnal movements differentiates patients with Parkinson's disease, but not high-risk individuals, from controls

“…All participants were investigated in the frame of the PMPP study (Progression Markers in the Premotor Phase of PD) 14 26. This study comprises a population of 16 patients with PD in early disease stages, 40 individuals supposed to be at high risk for PD (see below), and 14 controls with no risk marker for PD.…”

“…The start of the PD-specific neurodegenerative process may even be years to decades earlier than the characteristic motor symptoms which enable clinical diagnosis of PD. This prodromal phase is associated with an increased probability to have non-motor signs or symptoms (eg, hyposmia,7 8 rapid eye movement (REM), sleep behaviour disorder,9–11 depression,12 constipation12 13) and/or slight motor symptoms (eg, reduced arm swing, trunk instability,14 stiffness and slowness not sufficient for the diagnosis of PD but increasing the likelihood for its future onset15–17), and/or imaging abnormalities (eg, enlarged hyperechogenic substantia nigra18–20). However, the non-motor signs are not specific for PD as they are frequently present in the elderly population or co-occur with other diseases 21.…”

Effects of Exercise Therapy on Postural Instability in Parkinson Disease

“…3,4 It leads to loss of mobility, disability, and reduced quality of life. 5,6 Recent studies have shown that PI begins early after disease onset, 7,8 with around one third of individuals developing PI within the first 2 years after diagnosis. 5 Postural instability affects balance control in PD mainly in 4 domains: (1) balance during quiet stance, (2) reactive postural adjustments to external perturbations, (3) anticipatory postural adjustments, and (4) dynamic balance.…”

Vestibular function assessment using the NIH Toolbox

“…Accelerometers have been used to assess postural control 24 in older adults and to identify early symptoms of Parkinson disease. 25 A low-cost tool that quantifies postural sway using an accelerometer was developed by team members at the University of Pittsburgh. 26 A dual-axis accelerometer (ADXL213AE, 61.2 g; Analog Devices, Inc., Norwood, MA) was chosen for its low-frequency characteristics and because it was designed to optimally record mediolateral and anteroposterior acceleration of the pelvis/trunk during standing.…”