Elsevier

Gait & Posture

Volume 39, Issue 4, April 2014, Pages 1138-1141
Gait & Posture

Short Communication
Differential diagnosis of parkinsonism with visual inspection of posture and gait in the early stage

https://doi.org/10.1016/j.gaitpost.2014.01.004Get rights and content

Highlights

  • Differential diagnosis of parkinsonism is difficult in early stage.

  • We analyzed a structured visual inspection of gait and posture patterns.

  • Asymmetric arm-swing and accompanied tremor are suggestive of PD.

  • Staggering and en-bloc turning are suggestive atypical parkinsonism.

  • These analyses provide clues for differential diagnosis of parkinsonism.

Abstract

Background

Parkinson's disease (PD) differs from atypical parkinsonism in many clinical aspects. Principally, posture and gait are distinct features in the early stages of the disease; thus, these differences can be helpful in differential diagnosis.

Methods

We analyzed videos of patients with PD or atypical parkinsonism. A total of 76 patients with early PD (n = 56) or atypical parkinsonism (n = 20) were included. Items related to posture and gait were classified into three categories (standing, gait and associated symptoms) and each sub-item was analyzed.

Results

Asymmetric arm-swing (p = 0.004) and accompanying tremor (p = 0.016) were significant indicators of early-stage PD. Staggering gait (p = 0.007) and en-bloc turning (p = 0.026) were more common in atypical parkinsonism. Characteristics with a high odds-ratio for atypical parkinsonism were en-bloc turning (β = 8.475, p = 0.032) and normal arm-swing (β = 14.6084, p = 0.036).

Conclusions

Visual inspection of gait and posture provides reliable clues in the differential diagnosis of parkinsonism.

Introduction

Differentiating between Parkinson's disease (PD) and atypical parkinsonism (AP) in a clinical setting can be quite difficult; however, this distinction is crucial not only in determining prognosis, but also because appropriate management of these conditions may vary. Therefore, substantial research effort has been focused on this topic and several clinical features have been identified as ‘red flags’. Of the many diagnostic tools, clinical observation is the most useful, particularly in terms of gait and posture. Extant evidence suggests that asymmetric arm-swing is more prominent in early PD and that early postural instability is more prominent in those with AP [1]. Thus, a detailed analysis of gait and postural patterns for each disease may be helpful in early differential diagnosis. In this study, we performed a detailed clinical analysis of posture and gait and compared these items based on clinical diagnosis.

Section snippets

Subjects

Fifty-six PD patients and 20 AP patients were included in this study. All patients were clinically diagnosed with PD or AP at Korea University Guro Hospital. Motor scores, including gait and posture, had been previously recorded with a camcorder. We included patients who were within five years of initial symptom presentation, had a Hoeh and Yahr (H&Y) stage < 3, and were able to stand and walk without assistance. Clinical diagnosis was based on criteria set by the National Institute of

Demographics and basic characteristics

Fifty-six PD patients (male:female, 24:32), 16 MSA patients (male:female, 10:6) and 4 PSP patients (male:female, 4:1) were included. PD patients were significantly older than MSA patients (p = 0.005). H&Y stage was higher in the PD group compared to the AP group (p = 0.002), and disease duration for PSP patients was significantly longer than that of the PD group (p = 0.002) (Table 1).

Posture and gait video analysis in PD and AP

Posture and gait video analysis data and comparative results are presented in Table 2. Characteristics that varied

Discussion

Several studies have examined gait as a predictor of disease; however, few studies have performed a visual inspection of posture and gait features. This type of analysis can provide helpful clues in early diagnosis, and, using this tool, we found several significant features distinguishing PD and AP. First, asymmetric arm-swing and accompanied tremor were suggestive of PD. Second, staggering and en-bloc turning were characteristic of the gait pattern seen in early stage AP.

As mentioned in

Funding

None.

Conflict of interest statement

None declared.

References (9)

There are more references available in the full text version of this article.

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