The emerging postural instability phenotype in idiopathic Parkinson disease

Frank M Skidmore; William S Monroe; Christopher P Hurt; Anthony P Nicholas; Adam Gerstenecker; Thomas Anthony; Leon Jololian; Gary Cutter; Adil Bashir; Thomas Denny; David Standaert; Elizabeth A Disbrow

doi:10.1038/s41531-022-00287-x

The emerging postural instability phenotype in idiopathic Parkinson disease

NPJ Parkinsons Dis. 2022 Mar 18;8(1):28. doi: 10.1038/s41531-022-00287-x.

Authors

Frank M Skidmore^{1

2}, William S Monroe^{2

3

4}, Christopher P Hurt⁵, Anthony P Nicholas¹, Adam Gerstenecker¹, Thomas Anthony², Leon Jololian², Gary Cutter⁴, Adil Bashir⁶, Thomas Denny⁶, David Standaert¹, Elizabeth A Disbrow⁷

Affiliations

¹ Department of Neurology, University of Alabama at Birmingham, Birmingham, AL, USA.
² Department of Electrical & Computer Engineering, University of Alabama at Birmingham, Birmingham, AL, USA.
³ Department of Materials Science and Engineering, University of Alabama at Birmingham, Birmingham, AL, USA.
⁴ School of Public Health, Department of Biostatistics, University of Alabama at Birmingham, Birmingham, AL, USA.
⁵ Department of Physical Therapy, University of Alabama at Birmingham, Birmingham, AL, USA.
⁶ Department of Computer and Electrical Engineering, Auburn University, Auburn, AL, USA.
⁷ Department of Neurology, Center for Brain Health, Louisiana State University Health Sciences Center, Shreveport, LA, USA. elizabeth.disbrow@lsuhs.edu.

Abstract

Identification of individuals at high risk for rapid progression of motor and cognitive signs in Parkinson disease (PD) is clinically significant. Postural instability and gait dysfunction (PIGD) are associated with greater motor and cognitive deterioration. We examined the relationship between baseline clinical factors and the development of postural instability using 5-year longitudinal de-novo idiopathic data (n = 301) from the Parkinson's Progressive Markers Initiative (PPMI). Logistic regression analysis revealed baseline features associated with future postural instability, and we designated this cohort the emerging postural instability (ePI) phenotype. We evaluated the resulting ePI phenotype rating scale validity in two held-out populations which showed a significantly higher risk of postural instability. Emerging PI phenotype was identified before onset of postural instability in 289 of 301 paired comparisons, with a median progression time of 972 days. Baseline cognitive performance was similar but declined more rapidly in ePI phenotype. We provide an ePI phenotype rating scale (ePIRS) for evaluation of individual risk at baseline for progression to postural instability.

Abstract

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