Objective: Applying a three site multi-center approach, we aimed to identify the significant predictors of buttoning and unbuttoning in PD. We hypothesized that coin rotation is the most important determinant, but not bradykinesia or overall motor impairment.

Background: Parkinson’s disease (PD) is associated with impaired dexterity even at early-to-moderate disease stages. Reduced dexterity has a detrimental impact on typical activities of daily living (ADL) such as buttoning. It has been suggested that upper limb bradykinesia represents the most important determinant of dexterity skills. Only recently, limb-kinetic apraxia (LKA) was introduced as a second source of impaired dexterity in PD. It is defined as inability to make precise, independent but coordinated finger and hand movements. Coin rotation is its well-acknowledged surrogate task. Nevertheless, the relevance of LKA for typical ADL in PD has not been proven yet.

Methods: 64 right-handed, non-demented PD patients were recruited (30 female; age 63±10 years; Hoehn/Yahr 1-3). Buttoning, unbuttoning, coin rotation with the right and left hand, respectively, represented the 4 target tasks (maximum speed). Buttoning/unbuttoning consisted of opening/closing 5 buttons of a cardigan, and 20 flips of a US nickel were defined as coin rotation task (outcome variable: time for task completion). Motor impairment was assessed according to the UPDRS III (old version). Experiments were performed ON medication.

Results: Multiple linear regression analysis showed that coin rotation with the right hand was the only significant predictor of both buttoning (p<0.001) and unbuttoning (p=0.002) performance. Notably, measures of bradykinesia or overall motor impairment, age or disease duration were no significant predictors.

Conclusions: LKA seems relevant for ADL requiring fine motor skills in PD. The results change the notion of LKA as a pure academic phenomenon into a symptom with significant impact on everyday life of PD patients. They also stimulate further research into the pathophysiological basis of LKA and future treatment options, considering the limited response of LKA to dopaminergic therapy. Our results also show that the easy and quick to perform coin rotation test provides information about ADL-relevant dexterity skills in PD.

Annual Meeting of the Austrian Parkinson Society, Vienna, Austria, Oct 15-17 2015.

« Back to 2016 International Congress

MDS Abstracts - https://www.mdsabstracts.org/abstract/coin-rotation-as-strongest-predictor-of-buttoning-in-parkinsons-a-multicenter-study-demonstrating-the-everyday-impact-of-limb-kinetic-apraxia/