Objective: To investigate the frequency of subjective bed turning difficulties in a population at-risk for developing Parkinson’s disease (PD), its association motor and nonmotor features and its value for phenoconversion prediction.

Background: Recent wearable research suggests that nocturnal movements are disturbed in de novo Parkinson’s disease and may be an early sign of synucleinopathies.¹ This raises the question if patients already experience impaired bed mobility (such as bed turning difficulties) before PD diagnosis and if this symptom can contribute to phenoconversion prediction in populations at-risk.

Method: PPMI² data were downloaded in January 2021 for de novo PD subjects, subjects at-risk for developing a synucleinopathy (with isolated RBD, hyposmia or a pathogenic mutation [LRRK2, GBA or SNCA]) and controls. Bed turning difficulties at baseline were assessed with the MDS-UPDRS part 2 item 9, and a score ³ 1 was classified as positive. Frequency differences between groups were tested with chi-square tests. Multivariable logistic regression analyses were used to investigate associations with motor (MDS-UPDRS-3) and nonmotor variables (MoCA, UPSIT, SCOPA-AUT, STAI, ESS, RBDSQ, GDS). Unadjusted and adjusted cox proportional-hazards models were used to test if turning in bed difficulties predicts phenoconversion to PD or another synucleinopathy within 4 years in the at-risk group.

Results: Of the at-risk subjects, 9.7% experienced difficulties with bed turning vs. 2.5% of controls and 25.0% of de novo PD subjects (p<0.001). Within the at-risk and the de novo PD groups, impaired turning ability was associated with MDS-UPDRS-3 score (OR 1.1, p=0.005 and OR 1.1, p<0.001) and SCOPA-AUT score (OR 1.1, p=0.008 and OR 1.1, p=0.003). Using MDS-UPDRS-3 subscores, impaired turning ability was associated with axial signs in the at-risk group (OR 1.6, p<0.001) and with bradykinesia in the de novo PD group (OR 1.1, p<0.05). Phenoconversion was observed in 60/487 (12%) of the at-risk subjects. Impaired bed turning ability was a significant predictor for phenoconversion (HR 2.4, p=0.006), that was independent of nonmotor symptoms, but dependent on MDS-UPDRS-3 score.

Conclusion: Our findings suggest that subjective difficulties with turning in bed is a prodromal PD motor symptom, that is associated with autonomic dysfunction and may be useful in phenoconversion prediction in populations at-risk.

References: 1. Mirelman A, Hillel I, Rochester L, et al. Tossing and Turning in Bed: Nocturnal Movements in Parkinson’s Disease. Mov Disord. 2020;35:959–968. 2. Parkinson Progression Marker Initiative. The Parkinson Progression Marker Initiative (PPMI). Prog Neurobiol. 2011;95:629–635.

« Back to MDS Virtual Congress 2021

MDS Abstracts - https://www.mdsabstracts.org/abstract/difficulty-with-turning-in-bed-in-prediagnostic-parkinsons-disease/