Study Of Clinical Characteristics And Pathogenic Mechanism Of Parkinson's Disease With Concomitant Postural Abnormalities

OBJECTIVES1.To explore the clinical characteristics and associated factors of Parkinson's disease(PD)with concomitant postural abnormalities(PDPA)and thus provide evidences for its early detection.2.To explore the gait characteristics of patients with PDPA and thus provide the foundation for the following pathogenic mechanism study.3.To explore the pathogenic mechanism of patients with PDPA and thus provide references for early detection and intervention.METHODS1.PD patients admitted to the outpatient department of neurology of our hospital during February 1,2017 and September 30,2018 are recruited.According to the MDS-UPDRS,where the postural abnormality item scored less than 2 points means normal group,and equal to or more than 2 points means abnormal group,respectively.The scales and questionnaires of motor and non-motor functions between the two groups are analyzed.2.PD patients who completed measurement of abnormal angle of posture and 3D motor function test within the above subjects are recruited.Subjects whose trunk flexion forward over 30°(camptocormia,CC)or laterally over 10°(Pisa syndrome,PS)are in the abnormal group,while the others in the normal group.Motor function related parameters between the two groups are analyzed.3.PD patients from above subjects who completed resting-state functional magnetic resonance imaging(rs-f MRI)are recruited,and are grouped according to the same standard as above.Differences of function connectivity(FC)between the two groups are analyzed.RESULTS1.Longer disease duration,higher score of MDS-UPDRS part III,gait item,and postural stability item,and more application proportion of monoamine oxidase-B inhibitor(MAO-BI)are independent associated factors of PDPA.2.Decreased pelvic obliquity angles and progressively descending of center of mass(Co M)during walking are gait characteristics and independent associated factors of PDPA.3.PDPA shows poorer functional connectivity(FC)between left insula and bilateral supplementary motor areas(SMA),between right insula and bilateral middle frontal gyrus,compared with PD without postural abnormalities.In addition,the former one is significantly correlated with lower scores of Berg Balance Scale,the latter one is significantly correlated with decreased pelvic obliquity angle and longer time in Timed Up and Go test.CONCLUSIONS1.PDPA often occurs in PD patients with longer course of disease,and motor dysfunctions,gait dysfunctions and balance disabilities are common in these patients.In addition,this is the first clinical study in the world that confirms correlation between the application of MAO-BI and PDPA.2.This is the first study in the world that proves the decreased pelvic obliquity angle and progressively descending of Co M during walking the gait as characteristics of PDPA.Decreased pelvic obliquity angle influences gait function and balance ability.It is promising for progressive descending of Co M detected via 3D motor function test to be an independent predictor for postural abnormalities in PD.3.This is the first study in the world that indicates compared to PD without postural abnormalities,PDPA is characterized by decreased FC between left insula and bilateral SMA,and between right insula and bilateral middle frontal gyrus,which are probably the causes of gait dysfunctions in PDPA.