Objective: We aim to evaluate the incidence of axial postural abnormalities in patients with Parkinson’s disease (PD) and analyze their demographic and clinical predictors.

Background: Axial postural abnormalities are frequent and disabling symptoms in PD. However, they have been analyzed mainly in cross-sectional studies. Thus, data on their incidence and clinical predictors are lacking.

Method: We performed an analysis based on the data from the Parkinson Progression Marker Initiative (PPMI) study. The data was downloaded from the website of PPMI, www.ppmi-info.org on December 2022. We included 488 PD patients regularly followed-up for 4 years since PD diagnosis. The following data were collected at baseline (study enter), and at 1, 2, 3 and 4 year follow up: sex, age, Unified Parkinson’s Disease Rating Scale (UPDRS) part III, Hoehn and Yahr (HY), levodopa equivalent daily dose (LEDD), SCOPA-AUT for autonomic symptoms, RBD-Q for the presence of Rem sleep behavior disorder, and Benton Judgment of Line Orientation test (BJLOT) for visuospatial domain evaluation. We considered the presence of a postural abnormality a UPDRS part III posture item score ≥ 2 (moderately stooped posture, definitely abnormal). A Cox regression model was used to estimate the influence of the following factors at baseline on the development of postural abnormalities: age, UPDRS part III, LEDD, HY, BJLOT, SCOPA-AUT and RBD-Q.

Results: At the end of the 4-year follow-up, 30.9% of patients (n= 151/488) showed a postural abnormality; 9.6% (n= 47/488) already showed a postural abnormality at baseline. Five patients developed a highly severe postural abnormality (UPDRS part III posture item score = 4 – i.e., marked flexion with extreme abnormality of posture). The mean time for the development of a postural abnormality is 2.8 ± 1.8 years. The Cox model showed that age (OR 1.042; p<0.001) and UPDRS part III at baseline (OR 1.054; p<0.001) were the factors associated with the probability of developing postural abnormalities.

Conclusion: Our findings highlight the high incidence of axial postural abnormalities, even in the first years of PD. We found that an older age and a higher burden of motor symptoms at disease onset increase the probability for the development of a postural abnormality.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/incidence-and-predictors-of-axial-postural-abnormalities-in-parkinson-disease-data-from-the-ppmi-cohort/