Objective: We performed a multicenter, case-control study with the aim to analyze cognitive differences between parkinsonian patients with Pisa syndrome or camptocormia and matched controls with Parkinson’s disease (PD) without postural abnormalities (PA).

Background: Pisa syndrome and camptocormia are frequent complications of the PD clinical picture. The pathophysiology of these PA remains unclear, but the role of cognitive deficits has been postulated in pilot studies with small sample size.

Method: We performed a case-control study involving 7 Italian and 1 German Movement Disorders centers assessing demographic, clinical, and cognitive features of 114 PD patients: 32 with Pisa syndrome (PS+), 25 with camptocormia (CC+), 32 PD patients matched with PS+ patients for gender, age, level of education, PD duration, and PD stage (PS-), and 25 PD patients matched with CC+ patients for the same features (CC-).
A comprehensive neuropsychological battery was used to assess memory, attention, executive functions, visuospatial abilities, and language. The z-score, a numeric value obtained from the comparison between the patient’s raw score and the mean obtained by a group of healthy subjects from the same country, was used for each test and for the calculation of a cognitive domain score, and compared between groups using the Mann-Whitney U test.

Results: All groups were comparable for the main demographic and clinical features. Regarding cognition, PS+ patients showed significantly worse visuospatial performances than PS- (-1.29 – 95%IC -1.80, 0.01 – vs. -0.54 – 95%IC -0.97, 0.13 – p = 0.02), while CC+ did not show significant differences compared to CC-. The global cognitive assessment (MoCA) did not differ significantly between groups, nor did the scores regarding memory, executive functions, and language domains.

Conclusion: Our findings confirm preliminary data on the association of worse visuospatial abilities in PD patients with PS compared with PD patients without PA but with the same age, disease duration, and disease stage and characteristics. Moreover, we observed that patients with camptocormia did not have the same association, pointing toward different underlying pathophysiology between Pisa syndrome and camptocormia, with specific cognitive deficits related to visual-spatial abilities possibly implicated in the development of Pisa syndrome.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/visuospatial-deficits-characterize-pisa-syndrome-and-not-camptocormia-in-parkinsons-disease/