Relationship between Postural Deformities and Frontal Function in Parkinson’s Disease

Hindawi Publishing Corporation Parkinson’s Disease Volume 2015, Article ID 462143, 5 pages http://dx.doi.org/10.1155/2015/462143 Research Article Relationship between Postural Deformities and Frontal Function in Parkinson’s Disease Satoko Ninomiya, Akihiko Morita, Hiroko Teramoto, Takayoshi Akimoto, Hiroshi Shiota, and Satoshi Kamei Division of Neurology, Department of Medicine, Nihon University School of Medicine, 30-1 Oyaguchi Kami-cho, Itabashi-ku, Tokyo 173-8610, Japan Correspondence should be addressed to Akihiko Morita; Received 31 March 2015; Revised 18 June 2015; Accepted 18 June 2015 Academic Editor: Hélio Teive Copyright © 2015 Satoko Ninomiya et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Postural deformities and executive dysfunction (ED) are common symptoms of Parkinson’s disease (PD); however, the relationship between postural deformities and ED in patients with PD remains unclear. This study assessed the relationship between postural deformities and ED in patients with PD. Sixty-five patients with sporadic PD were assessed for the severity of postural deformities and executive function. The severity of postural deformities was scored using the United Parkinson’s Disease Rating Scale item 28 score: no postural deformity (0), mild postural deformities (1), or severe postural deformities (2–4). Executive function was assessed using the Behavioral Assessment of the Dysexecutive Syndrome (BADS) and an age-controlled standardized BADS score <70 was defined as ED. Age-controlled standardized BADS scores were compared across the three groups using the Kruskal-Wallis test. Relationship between ED and the severity of postural deformities was assessed using the Mann-Whitney U test. Age-controlled standardized BADS score significantly differed among the three groups (𝑃 = 0.005). ED was significantly related to the severity of postural deformities (𝑃 = 0.0005). The severity of postural deformities was associated with a lower age-controlled standardized BADS score and ED, and these findings suggest that postural deformities were associated with frontal dysfunction in patients with PD. 1. Introduction Parkinson’s disease (PD) is a chronic neurodegenerative disease characterized by motor symptoms such as akinesia, rigidity, resting tremor and postural abnormalities, and nonmotor symptoms including dementia, depression, and executive dysfunction (ED) [1]. These symptoms have a major negative impact on the quality of life of patients with PD [2]. Postural abnormalities in patients with PD include deformities and instability [3]. Postural deformities such as stooped posture, camptocormia, anterocollis, dropped head syndrome, Pisa syndrome, and scoliosis induce clinical impairment at the late stage of PD [3, 4]. Postural instability is due to dysfunctional postural reflexes and causes falls and gait disturbances [3]. Previous studies have reported that postural deformities in patients with PD were caused by dystonia, rigidity, impaired proprioception, and kinesthesia; however, the underlying pathophysiology of postural deformities in patients with PD is unknown [4]. Some studies have suggested that postural instability and gait disturbance significantly correlate with ED [5, 6]. However, the relationship between postural deformities and ED in patients with PD has not been determined. The Behavioural Assessment of the Dysexecutive Syndrome (BADS) [7] is a neuropsychological battery that is used to assess ED with ecological validity and it is sensitive to ED in PD patients [8]. We previously evaluated the relationship between the freezing of gait and ED using the BADS in patients with PD [9]. The present study assessed the relationship between postural deformities and ED in patients with PD. 2. Patients and Methods 2.1. Patients. Consecutive patients who were diagnosed with sporadic PD according to the United Kingdom Parkinson’s Disease Brain Bank criteria [10] at the Neurology Clinic, 2 Parkinson’s Disease Table 1: Demographics and disease characteristics of the patients. 𝑛 Age, years Male Disease duration, months HY stage UPDRS total score MMSE score No postural deformity 20 56.5 (34, 76) 12 (60%) 60 (12, 228) 2 (1, 2) 24 (13, 41) 29 (24, 30) Mild postural deformities 30 71 (50, 84) 14 (42%) 57 (1, 138) 3 (2, 3) 38 (20, 61) 26.5 (19, 30) Severe postural deformities 9 71.5 (57, 84) 5 (42%) 89 (36, 216) 3.5 (2, 5) 57.5 (30, 111) 25.5 (6, 30) 𝑃 <0.001∗ 0.421 0.017∗ <0.001∗ <0.001∗ 0.087 Data are expressed as median (minimum, maximum) or 𝑛 (%). HY: Hoehn and Yahr; 𝑛: number of patients; MMSE: Mini-Mental State Examination; UPDRS: Unified Parkinson’s Disease Rating Scale. UPDRS item 28 score of 0, 1, and 2–4 were used to define no postural deformity, mild postural deformities, and severe postural deformities, respectively. 𝑃 values were calculated using the Kruskal-Wallis test or Fisher’s exact test as appropriate. ∗ Statistically significant (𝑃 < 0.05). Nihon University Itabashi Hospital, between December 2006 and October 2008, were enrolled. Patients diagnosed with other forms of parkinsonism such as dementia with Lewy bodies [11, 12], drug-induced parkinsonism, vascular parkinsonism, and atypical parkinsonism with absent or minimal responses to antiparkinsonian drugs were excluded. All patients were assessed using cranial magnetic resonance imaging and those with intracerebral ischemic changes including a single asymptomatic lacuna or slight periventricular hyperintensity according to the reported classification of periventricular hyperintensity [13] were excluded. All patients were assessed using the United Parkinson’s Disease Rating Scale (UPDRS) [14] and the Mini-Mental State Examination (MMSE) based on the Diagnostic and Statistical Manual of Mental Disorders, 4th edition (DSM-IV) [15]. Executive function was assessed using the BADS [16]. ED was defined as an age-controlled standardized BADS score <70 [7, 16]. Informed written consent for participation in the present study was obtained from each patient according to a protocol approved by Institutional Research Review Board of Nihon University. 2.2. Assessment of Postural Deformities. The severity of postural deformities was assessed using UPDRS item 28 score, which classified patients into five grades according to severity: (0) normal erect, (1) not quite erect, slightly stooped posture: it could be normal for older person, (2) moderately stooped posture, definitely abnormal: it can be slightly leaning to one side, (3) severely stooped posture with kyphosis: it can be moderately leaning to one side, and (4) marked flexion with extreme abnormality of posture. The patients were classified into three groups according to UPDRS item 28 score: no postural deformity (score of 0), mild postural deformities (score of 1), or severe postural d (...truncated)