Artusi Carlo Alberto, Montanaro Elisa, Erro Roberto, Margraf Nils, Geroin Christian, Pilotto Andrea, Magistrelli Luca, Spagnolo Francesca, Marchet Alberto, Sarro Lidia, Cuoco Sofia, Sacchetti Marta, Riello Marianna, Capellero Barbara, Berchialla Paola, Moeller Bettina, Vullriede Beeke, Zibetti Maurizio, Rini Augusto Maria, Barone Paolo, Comi Cristoforo, Padovani Alessandro, Tinazzi Michele, Lopiano Leonardo
Department of Neuroscience "Rita Levi Montalcini" University of Torino Torino Italy.
Neurology 2 Unit Azienda Ospedaliero-Universitaria Città della Salute e della Scienza di Torino Torino Italy.
Mov Disord Clin Pract. 2022 Nov 14;10(1):64-73. doi: 10.1002/mdc3.13605. eCollection 2023 Jan.
Pisa syndrome (PS) and camptocormia (CC) are postural abnormalities frequently associated with Parkinson's disease (PD). Their pathophysiology remains unclear, but the role of cognitive deficits has been postulated.
To identify differences in the neuropsychological functioning of patients with PD with PS or CC compared with matched patients with PD without postural abnormalities.
We performed a case-control study including 57 patients with PD with PS (PS+) or CC (CC+) and 57 PD controls without postural abnormalities matched for sex, age, PD duration, phenotype, and stage. Patients were divided into four groups: PS+ (n = 32), PS+ controls (PS-, n = 32), CC+ (n = 25), and CC+ controls (CC-, n = 25). We compared PS+ versus PS- and CC+ versus CC- using a neuropsychological battery assessing memory, attention, executive functions, visuospatial abilities, and language. Subjective visual vertical (SVV) perception was assessed by the Bucket test as a sign of vestibular function; the misperception of trunk position, defined as a mismatch between the objective versus subjective evaluation of the trunk bending angle >5°, was evaluated in PS+ and CC+.
PS+ showed significantly worse visuospatial performances ( = 0.025) and SVV perception ( = 0.038) than their controls, whereas CC+ did not show significant differences compared with their control group. Reduced awareness of postural abnormality was observed in >60% of patients with PS or CC.
Low visuospatial performances and vestibular tone imbalance are significantly associated with PS but not with CC. These findings suggest different pathophysiology for the two main postural abnormalities associated with PD and can foster adequate therapeutic and prevention strategies.
Pisa综合征（PS）和脊柱前凸（CC）是帕金森病（PD）常见的姿势异常。其病理生理学尚不清楚，但认知缺陷的作用已被提出。
确定伴PS或CC的PD患者与无姿势异常的匹配PD患者在神经心理功能上的差异。
我们进行了一项病例对照研究，纳入57例伴PS（PS+）或CC（CC+）的PD患者以及57例无姿势异常的PD对照，两组在性别、年龄、PD病程、表型和分期方面相匹配。患者分为四组：PS+（n = 32）、PS+对照组（PS-，n = 32）、CC+（n = 25）和CC+对照组（CC-，n = 25）。我们使用评估记忆、注意力、执行功能、视觉空间能力和语言的神经心理测试组比较PS+与PS-以及CC+与CC-。通过水桶试验评估主观视觉垂直（SVV）感知作为前庭功能的指标；在PS+和CC+中评估躯干位置的错误感知，定义为躯干弯曲角度的客观与主观评估之间的不匹配>5°。
PS+组的视觉空间表现（P = 0.025）和SVV感知（P = 0.038）明显差于其对照组，而CC+组与其对照组相比未显示出显著差异。超过60%的PS或CC患者存在姿势异常意识降低。
低视觉空间表现和前庭张力失衡与PS显著相关，但与CC无关。这些发现提示与PD相关的两种主要姿势异常具有不同的病理生理学，可为适当的治疗和预防策略提供依据。
