Comparing postural instability and gait disorder and akinetic-rigid subtyping of Parkinson disease and their stability over time
Corresponding Author
R. Erro
Center for Neurodegenerative Disease – CEMAND, Department of Medicine, Surgery and Dentistry ‘Scuola Medica Salernitana’, University of Salerno, Baronissi (SA), Italy
*Correspondence: R. Erro, Center for Neurodegenerative Disease – CEMAND, Department of Medicine, Surgery and Dentistry ‘Scuola Medica Salernitana’, University of Salerno, Via S. Allende, 84081, Baronissi (SA), Italy (tel.:/fax: +39 089672462; e-mail: [email protected]).Search for more papers by this authorM. Picillo
Center for Neurodegenerative Disease – CEMAND, Department of Medicine, Surgery and Dentistry ‘Scuola Medica Salernitana’, University of Salerno, Baronissi (SA), Italy
Search for more papers by this authorM. Amboni
Center for Neurodegenerative Disease – CEMAND, Department of Medicine, Surgery and Dentistry ‘Scuola Medica Salernitana’, University of Salerno, Baronissi (SA), Italy
Institute of Diagnosis and Health, IDC-Hermitage Capodimonte, Naples, Italy
Search for more papers by this authorR. Savastano
Azienda Ospedaliera Universitaria 'San Giovanni di Dio e Ruggi d'Aragona', Salerno, Italy
Search for more papers by this authorS. Scannapieco
Center for Neurodegenerative Disease – CEMAND, Department of Medicine, Surgery and Dentistry ‘Scuola Medica Salernitana’, University of Salerno, Baronissi (SA), Italy
Search for more papers by this authorS. Cuoco
Center for Neurodegenerative Disease – CEMAND, Department of Medicine, Surgery and Dentistry ‘Scuola Medica Salernitana’, University of Salerno, Baronissi (SA), Italy
Search for more papers by this authorG. Santangelo
Department of Psychology, University of Campania Luigi Vanvitelli, Caserta, Italy
Search for more papers by this authorC. Vitale
Institute of Diagnosis and Health, IDC-Hermitage Capodimonte, Naples, Italy
Department of Motor Sciences and Wellness, University ‘Parthenope’, Naples, Italy
Search for more papers by this authorM. T. Pellecchia
Center for Neurodegenerative Disease – CEMAND, Department of Medicine, Surgery and Dentistry ‘Scuola Medica Salernitana’, University of Salerno, Baronissi (SA), Italy
Search for more papers by this authorP. Barone
Center for Neurodegenerative Disease – CEMAND, Department of Medicine, Surgery and Dentistry ‘Scuola Medica Salernitana’, University of Salerno, Baronissi (SA), Italy
Search for more papers by this authorCorresponding Author
R. Erro
Center for Neurodegenerative Disease – CEMAND, Department of Medicine, Surgery and Dentistry ‘Scuola Medica Salernitana’, University of Salerno, Baronissi (SA), Italy
*Correspondence: R. Erro, Center for Neurodegenerative Disease – CEMAND, Department of Medicine, Surgery and Dentistry ‘Scuola Medica Salernitana’, University of Salerno, Via S. Allende, 84081, Baronissi (SA), Italy (tel.:/fax: +39 089672462; e-mail: [email protected]).Search for more papers by this authorM. Picillo
Center for Neurodegenerative Disease – CEMAND, Department of Medicine, Surgery and Dentistry ‘Scuola Medica Salernitana’, University of Salerno, Baronissi (SA), Italy
Search for more papers by this authorM. Amboni
Center for Neurodegenerative Disease – CEMAND, Department of Medicine, Surgery and Dentistry ‘Scuola Medica Salernitana’, University of Salerno, Baronissi (SA), Italy
Institute of Diagnosis and Health, IDC-Hermitage Capodimonte, Naples, Italy
Search for more papers by this authorR. Savastano
Azienda Ospedaliera Universitaria 'San Giovanni di Dio e Ruggi d'Aragona', Salerno, Italy
Search for more papers by this authorS. Scannapieco
Center for Neurodegenerative Disease – CEMAND, Department of Medicine, Surgery and Dentistry ‘Scuola Medica Salernitana’, University of Salerno, Baronissi (SA), Italy
Search for more papers by this authorS. Cuoco
Center for Neurodegenerative Disease – CEMAND, Department of Medicine, Surgery and Dentistry ‘Scuola Medica Salernitana’, University of Salerno, Baronissi (SA), Italy
Search for more papers by this authorG. Santangelo
Department of Psychology, University of Campania Luigi Vanvitelli, Caserta, Italy
Search for more papers by this authorC. Vitale
Institute of Diagnosis and Health, IDC-Hermitage Capodimonte, Naples, Italy
Department of Motor Sciences and Wellness, University ‘Parthenope’, Naples, Italy
Search for more papers by this authorM. T. Pellecchia
Center for Neurodegenerative Disease – CEMAND, Department of Medicine, Surgery and Dentistry ‘Scuola Medica Salernitana’, University of Salerno, Baronissi (SA), Italy
Search for more papers by this authorP. Barone
Center for Neurodegenerative Disease – CEMAND, Department of Medicine, Surgery and Dentistry ‘Scuola Medica Salernitana’, University of Salerno, Baronissi (SA), Italy
Search for more papers by this authorAbstract
Background and purpose
Parkinson disease (PD) patients are classically classified according to two alternative motor subtyping methods: (i) tremor-dominant versus postural instability and gait disorder; (ii) tremor-dominant versus akinetic-rigid. The degree of overlap between the two classification systems at diagnosis of PD and their temporal stability, as well as the correspondence between the two systems, were examined over a follow-up period of 4 years.
Methods
Newly diagnosed, untreated PD patients were classified as tremor-dominant versus postural instability and gait disorder and tremor-dominant versus akinetic-rigid at baseline and after 2 and 4 years.
Results
There was a poor overlap between the two classification systems at any time point and baseline subtype status could not predict 4-year subtype membership. In fact, about half of our cohort shifted category during the first 2 years, regardless of the classification scheme adopted. A lower rate of shift was observed from 2- to 4-year follow-up.
Conclusions
The two classical motor subtyping methods of PD poorly overlap, which implies that a patient can be categorized as tremor-dominant in one classification system but not in the other. Moreover, their temporal instability undermines their prognostic value in the early stage of PD.
Disclosure of conflicts of interest
The authors declare no financial or other conflicts of interest.
Supporting Information
| Filename | Description |
|---|---|
| ene13968-sup-0001-TableS1-S3.pdfPDF document, 267.4 KB |
Table S1. Demographic and clinical features of the cohort. Table S2. Distribution of the subtypes according to the Jankovic (rows) and Schiess (columns) classification systems at baseline (a) and at 2-year (b) and 4-year (c) follow-up. Table S3. Demographic and clinical features of the subtypes at baseline (a) and at 2-year (b) and 4-year (c) follow-up. Significant values (P < 0.05) are expressed in bold. |
Please note: The publisher is not responsible for the content or functionality of any supporting information supplied by the authors. Any queries (other than missing content) should be directed to the corresponding author for the article.
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