Pantall Annette, Del Din Silvia, Rochester Lynn
Institute of Neuroscience/Newcastle University Institute of Ageing, Newcastle upon Tyne, United Kingdom.
Institute of Neuroscience/Newcastle University Institute of Ageing, Newcastle upon Tyne, United Kingdom; The Newcastle upon Tyne NHS Foundation Trust, Newcastle upon Tyne, United Kingdom.
Gait Posture. 2018 May;62:468-474. doi: 10.1016/j.gaitpost.2018.04.016. Epub 2018 Apr 13.
Postural instability is a common motor feature in people with Parkinson's disease (PD) together with non-motor features such as cognitive dysfunction. Management of postural instability is challenging as it is often resistant to dopaminergic therapy. Greater knowledge of postural control is essential to understand postural instability in PD.
This study aimed to answer how postural control differs in people with PD compared to healthy older adults (HOA). Additionally, postural control changes over a 36 month period and its relationship to cognitive impairment and motor scores were investigated.
The study group consisted of 50 people diagnosed with PD and 59 HOAs, recruited as part of an incident cohort study (ICICLE-GAIT). Participants stood still for 2 min, eyes open and arms by their side. A single tri-axial accelerometer (Axivity AX3, York, UK) on the lower back recorded acceleration. Measurements were taken at 18, 36 and 54 months after recruitment. Sample entropy (SampEn), which measures signal predictability, was determined for the accelerometry data. Cognitive tests included the Montreal Cognitive Assessment and the Unified Parkinson's Disease Rating Scale (UPDRS III) quantified motor function. Linear mixed models, regression analysis and correlation analysis were applied to the data.
indicated that SampEn was greater for the PD group at all three time-points and along all three axes. However, there was no increase of SampEn with disease progression. Higher SampEn values were associated with greater cognitive impairment and lower UPDRS III, although correlations were weak. There was a difference between axial directions and cognitive and motor scores.
People with PD exhibit decreased regularity of trunk dynamics when standing compared to HOAs. Nonlinear accelerometer metrics along all three axes are therefore a potential biomarker of PD. The relationship between trunk dynamics and cognitive function indicates common neural pathways.
姿势不稳是帕金森病（PD）患者常见的运动特征，同时伴有认知功能障碍等非运动特征。姿势不稳的管理具有挑战性，因为它通常对多巴胺能治疗有抵抗性。深入了解姿势控制对于理解PD中的姿势不稳至关重要。
本研究旨在回答与健康老年人（HOA）相比，PD患者的姿势控制有何不同。此外，还研究了36个月期间姿势控制的变化及其与认知障碍和运动评分的关系。
研究组由50名被诊断为PD的患者和59名HOA组成，作为一项队列研究（ICICLE-GAIT）的一部分被招募。参与者双脚并拢站立2分钟，双眼睁开，双臂自然下垂。在下背部佩戴一个单轴加速度计（Axivity AX3，英国约克）记录加速度。在招募后的18、36和54个月进行测量。对加速度计数据确定样本熵（SampEn），它用于测量信号可预测性。认知测试包括蒙特利尔认知评估，统一帕金森病评定量表（UPDRS III）用于量化运动功能。对数据应用线性混合模型、回归分析和相关分析。
表明在所有三个时间点以及所有三个轴向上，PD组的SampEn都更高。然而，SampEn并未随疾病进展而增加。尽管相关性较弱，但较高的SampEn值与更严重的认知障碍和较低的UPDRS III相关。轴向方向与认知和运动评分之间存在差异。
与HOA相比，PD患者站立时躯干动力学的规律性降低。因此，沿所有三个轴的非线性加速度计指标是PD的潜在生物标志物。躯干动力学与认知功能之间的关系表明存在共同的神经通路。
