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Characterization of postural instability in atypical parkinsonian syndromes
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Abstract(s)
Introdução: Os Parkinsonismos Atípicos (AP) são um grupo de doenças
neurodegenerativas que partilham sintomas com a Doença de Parkinson (PD), mas
distinguem-se por uma progressão mais rápida, quedas mais precoces e menor prevalência.
Embora a instabilidade postural seja comum nestas condições, a sua caracterização detalhada
entre os diferentes subtipos de PA permanece subexplorada. Este estudo tem como objetivo
caracterizar a instabilidade postural nos subtipos de AP: Paralisia Supranuclear Progressiva
(PSP), Atrofia Multissistêmica (MSA), Demência de Corpos de Lewy (DLB) e Degeneração
Corticobasal (CBD).
Metodologia: Este estudo transversal e retrospetivo incluiu 120 participantes com AP e um
grupo de comparação com 262 participantes com PD, recrutados no CNS - Campus
Neurológico entre setembro de 2017 e julho de 2023. A extração de dados foi realizada na
plataforma DataPark, utilizando a Mini-BESTest como outcome primário.
Resultados: Os participantes com AP apresentaram uma pontuação total na Mini-BESTest
de 11.10 ± 7.67/28, sem diferença significativa entre si, com o pior desempenho nos
participantes com CBD (10.40 ± 5.58/28) e o melhor nos DLB (11.47 ± 7.59/28). Os
domínios com pontuações mais baixas foram o controle postural reativo (1.3-1.6/6) e os
ajustes posturais antecipatórios (2.0-2.2/6). Em comparação, os participantes com PD
apresentaram scores significativamente mais altos (17.19 ± 7.67/28). Todos os grupos
apresentaram pontuações abaixo do valor de referência para risco de quedas nesta escala.
Conclusão: Não foram encontradas diferenças significativas entre os subtipos de AP em
relação à instabilidade postural. No entanto, todos os grupos de AP apresentaram
dificuldades semelhantes no controlo postural reativo e antecipatório, com diferenças
observadas na marcha dinâmica. Estes resultados destacam a necessidade de intervenções
personalizadas com base nos desafios específicos de cada subtipo e o papel da envolvência
familiar na gestão da instabilidade postural.
Introduction: Atypical Parkinsonisms (AP) are a group of neurodegenerative diseases that share symptoms with Parkinson's disease (PD), but are distinguished by more rapid progression, earlier and more frequent falls, and lower prevalence. While postural instability is common in these conditions, its detailed characterization across the different AP subtypes remains underexplored. This study aims to characterize postural instability in four AP subtypes: Progressive Supranuclear Palsy (PSP), Multiple System Atrophy (MSA), Dementia with Lewy Body (DLB), and Corticobasal Degeneration (CBD). Methodology: This cross-sectional and retrospective study included 120 participants with AP and a comparison group of 262 participants with PD, recruited at CNS - Campus Neurológico between September 2017 and July 2023. Data extraction was performed on DataPark platform, using the Mini-BESTest as primary outcome. Results: Participants with AP had an average total score of 11.10 ± 7.67/28 on the MiniBESTest, with no statistically significant differences between subtypes. The lowest performance was observed in the CBD group (10.40 ± 5.58/28) and the highest in the DLB group (11.47 ± 7.59/28). The domains with the lowest scores were reactive postural control (1.3-1.6/6) and anticipatory postural adjustments (2.0-2.2/6). In comparison, participants with PD had a statistically significantly higher average total score of 17.19 ± 7.67/28 (p<0.05). All groups, including those with AP, scored below the reference cutoff for fall risk according to the Mini-BESTest. Conclusion: No significant differences were found between AP subtypes regarding postural instability. However, all AP groups exhibited similar difficulties in reactive and anticipatory postural control and showed differences in dynamic gait tasks. These findings emphasize the need for personalized interventions based on subtype-specific challenges and the role of family involvement in the management of postural instability.
Introduction: Atypical Parkinsonisms (AP) are a group of neurodegenerative diseases that share symptoms with Parkinson's disease (PD), but are distinguished by more rapid progression, earlier and more frequent falls, and lower prevalence. While postural instability is common in these conditions, its detailed characterization across the different AP subtypes remains underexplored. This study aims to characterize postural instability in four AP subtypes: Progressive Supranuclear Palsy (PSP), Multiple System Atrophy (MSA), Dementia with Lewy Body (DLB), and Corticobasal Degeneration (CBD). Methodology: This cross-sectional and retrospective study included 120 participants with AP and a comparison group of 262 participants with PD, recruited at CNS - Campus Neurológico between September 2017 and July 2023. Data extraction was performed on DataPark platform, using the Mini-BESTest as primary outcome. Results: Participants with AP had an average total score of 11.10 ± 7.67/28 on the MiniBESTest, with no statistically significant differences between subtypes. The lowest performance was observed in the CBD group (10.40 ± 5.58/28) and the highest in the DLB group (11.47 ± 7.59/28). The domains with the lowest scores were reactive postural control (1.3-1.6/6) and anticipatory postural adjustments (2.0-2.2/6). In comparison, participants with PD had a statistically significantly higher average total score of 17.19 ± 7.67/28 (p<0.05). All groups, including those with AP, scored below the reference cutoff for fall risk according to the Mini-BESTest. Conclusion: No significant differences were found between AP subtypes regarding postural instability. However, all AP groups exhibited similar difficulties in reactive and anticipatory postural control and showed differences in dynamic gait tasks. These findings emphasize the need for personalized interventions based on subtype-specific challenges and the role of family involvement in the management of postural instability.
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Keywords
Parkinsonismo Atípico Doença de Parkinson Equilíbrio MiniBESTest Quedas Parkinson-Plus syndromes Parkinson disease Balance Falls