npj Parkinsons Dis: Postural instability phenotype becomes increasingly important in idiopathic Parkinson's disease

A long recognized transition point in the development of Parkinson's disease (PD)-related disability is the development of postural instability
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The relationship between disability, gait, and balance is often examined through the prism of the Hoehn and Yahr (HY) scale, the first widely used PD severity scale

A long recognized transition point in the development of Parkinson's disease (PD)-related disability is the development of postural instability

Figure 1 Title map of the paper

Figure 1 Title map of the paper

Severity is graded using the following criteria
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Severity is graded using the following criteria
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(1) Unilateral involvement with little or no functional impairment;

(1) Unilateral involvement with little or no functional impairment;

(2) bilateral or midline involvement without balance disturbance;

(2) bilateral or midline involvement without balance disturbance;

(3) Bilateral disease, mild to moderate disability, impaired postural reflexes, and physical independence;

(3) Bilateral disease, mild to moderate disability, impaired postural reflexes, and physical independence;

(4) Severely disabling diseases, still able to walk without barriers;

(4) Severely disabling diseases, still able to walk without barriers;

(5) Restricted to bed or wheelchair unless assisted
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Jankovic and colleagues later developed the Postural Instability/Gait Disorder (PIGD) score, derived from the Unified Parkinson's Disease Rating Scale (UPDRS), a widely used structured medical history and clinical examination

(5) Restricted to bed or wheelchair unless assisted

The study by Haaxma and colleagues showed that new patients initially presenting with tremor had a mean time to onset of 3.

Alves and colleagues found that 60 of the 61 patients identified with dementia at the start of the study had clinically meaningful gait and balance impairments, findings consistent with a single disease mechanism

Thus, disease progression also plays a role in the assignment of phenotypes

Using 5-year longitudinal castration idiopathic data (n = 301) from the Parkinson's Disease Progression Markers Initiative (PPMI), they investigated the association between baseline clinical factors and the development of postural instability

Figure 2 Changes in PIGD score during follow-up

Figure 2 Changes in PIGD score during follow-up

Logistic regression analysis showed baseline characteristics associated with future postural instability, and they named this cohort the emerging postural instability (ePI) phenotype
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Logistic regression analysis showed baseline characteristics associated with future postural instability, and they named this cohort the emerging postural instability (ePI) phenotype
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They assessed the validity of the resulting ePI phenotype scale in two unchanged populations with a significantly higher risk of postural instability
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They assessed the validity of the resulting ePI phenotype scale in two unchanged populations with a significantly higher risk of postural instability
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In 289 of 301 pairwise comparisons, emerging PI phenotypes were identified before the onset of postural instability, with a median time to progression of 972 days
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In 289 of 301 pairwise comparisons, emerging PI phenotypes were identified before the onset of postural instability, with a median time to progression of 972 days
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Baseline cognitive performance was similar, but declined more rapidly in the ePI phenotype
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Baseline cognitive performance was similar, but declined more rapidly in the ePI phenotype
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The significance of this study is the discovery of an ePI phenotype scale (ePIRS) to assess an individual's risk of developing postural instability at baseline
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The significance of this study is the discovery of an ePI phenotype scale (ePIRS) to assess an individual's risk of developing postural instability at baseline
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Source:
Skidmore FM, Monroe WS, Hurt CP, et al.
The emerging postural instability phenotype in idiopathic Parkinson disease.
npj Parkinsons Dis.
2022;8(1):28.
doi:10.
1038/s41531-022-00287-x

Source:
Skidmore FM, Monroe WS, Hurt CP, et al.
The emerging postural instability phenotype in idiopathic Parkinson disease.
npj Parkinsons Dis.
2022;8(1):28.
doi:10.
1038/s41531-022-00287-x Skidmore FM, Monroe WS, Hurt CP, et al.
The emerging postural instability phenotype in idiopathic Parkinson disease.
npj Parkinsons Dis.
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