Article

Parkinson disease (PD) may lead to functional limitations through
both motor and nonmotor symptoms. Although patients with advanced disease have
well-documented and profound functional limitations, less is known about the
determinants of function in early to mid-stage disease where interventions may be
more likely to benefit and preserve function.
The objective of the
current study was to identify motor, cognitive, and gait determinants of physical
functional performance in patients with early to mid-stage PD.
DESIGN: This was a
secondary analysis of cross-sectional baseline data from a randomized clinical
trial of exercise. SETTING: The study was performed at a tertiary academic
medical center. PARTICIPANTS: The study included 121 patients with early to
mid-stage PD. METHODS: Our functional performance outcomes included the
following: the Continuous Scale Physical Functional Performance Test (CS-PFP;
primary outcome); the Timed Up and Go test (TUG); and Section 2 (Activities of
Daily Living) of the Unified Parkinson's Disease Rating Scale (UPDRS).
Explanatory variables included measures of disease severity, motor function,
cognitive function, balance, and gait. Stepwise linear regression models were
used to determine correlations between explanatory variables and outcome
measures. RESULTS: In our regression models, the CS-PFP significantly correlated
with walking endurance (Six-Minute Walk Test; r(2) = 0.12, P < .0001), turning
ability (360 degrees Turn Test; r(2) = 0.03, P = .002), attention (Brief Test of
Attention; r(2) = 0.01, P = .03), overall cognitive status (Mini-Mental State
Examination; r(2) = 0.01, P = .04), and bradykinesia (timed tapping; r(2) = 0.02,
P = .02). The TUG significantly correlated with walking speed (5-Meter Walk Test;
r(2) = 0.33, P < .0001), stride length (r(2) = 0.25, P < .0001), turning ability
(360 degrees turn, r(2) = 0.05, P = .0003), and attention (r(2) = 0.016, P =
.03). Section 2 of the UPDRS was significantly correlated with endurance (r(2) =
0.09, P < .0001), turning ability (r(2) = 0.03, P = .001), and attention (r(2) =
0.01, P = .03). CONCLUSIONS: Gait, motor, and cognitive function all contribute
to objectively measured global functional ability in mild to moderate PD.
Subjectively measured functional activity outcomes may underestimate the impact
of both motor and nonmotor symptoms.
CI - Copyright (c) 2014 American Academy of Physical Medicine and Rehabilitation.
Published by Elsevier Inc. All rights reserved.

Langue : ANGLAIS