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Micrographia and related deficits in Parkinson's disease: a cross-sectional study
Aparna Wagle Shukla1, Songthip Ounpraseuth, Michael S Okun
1Department of Neurology, University of Florida, Center for Movement Disorders and Neurorestoration, Gainesville, Florida, USA.
Objectives:
To determine the prevalence and clinical features associated with micrographia in Parkinson's Disease (PD).
Setting:
This study was conducted at a Movement Disorders clinic located in a Veteran Administration Hospital.
Participants:
PD subjects were included only if they satisfied UK Parkinson's Disease Society criteria for diagnosis. Subjects with history of severe tremors, dystonia, dyskinesia, strokes, peripheral neuropathy and dementia were excluded.
Design:
This was a case-control study where PD subjects were prospectively enrolled and their demographics, Hoehn & Yahr stage, Unified Parkinson's Disease Rating Scale and Mini Mental Status examination (MMSE) scores were recorded. All subjects were specifically asked for micrographia on history and the handwritings were quantitatively documented. Bradykinesia was determined by history and quantified by a finger tap, Purdue pegboard and a timed walk test. Similarly, hypophonia was determined by history and the volume of speech quantified using a decibel meter. Controls were enrolled for validation of handwriting test scores and decibel meter recordings.
Primary Outcome Measures:
Prevalence of micrographia in the PD cohort and the clinical factors that correlate with micrographia.
Results:
68 subjects with PD were enrolled (68 men; mean age 72.3 years). Micrographia was identified in 63.2% of the cohort on verbal history and in 50% of the cohort when the handwriting test was used for ascertainment. Micrographia ascertained on history correlated significantly with disease severity (Hoehn & Yahr stage), motor impairment (Unified Parkinson's Disease Rating Scale), cognitive impairment (MMSE) and both bradykinesia and hypophonia determined by history and quantitative testing. Micrographia on handwriting test correlated with age (p=0.02), MMSE testing (p=0.04), hypophonia by history (p=0.01) and bradykinesia by quantitative testing (p=0.04).
Conclusion:
Micrographia was found in nearly half of the PD cohort. Disease severity and impaired cognition were important clinical correlates. Micrographia had a significant relationship with bradykinesia and hypophonia, suggesting a possible overlap in their pathophysiology.
Insights
Micrographia affects nearly half of Parkinson
Area of Science:
- Neurology
- Movement Disorders
- Geriatric Medicine
Background:
- Parkinson's Disease (PD) is a neurodegenerative disorder characterized by motor and non-motor symptoms.
- Micrographia, a common motor symptom in PD, involves progressive shrinking of handwriting.
- Understanding the prevalence and clinical correlates of micrographia is crucial for patient management.
Purpose of the Study:
- To determine the prevalence of micrographia in Parkinson's Disease (PD) patients.
- To identify clinical features associated with micrographia in PD.
- To explore the relationship between micrographia and other PD symptoms.
Main Methods:
- A case-control study was conducted at a Movement Disorders clinic.
- 68 PD subjects meeting UK PD Society criteria were enrolled, excluding those with severe tremors, dystonia, dyskinesia, strokes, neuropathy, or dementia.
- Data collected included demographics, Hoehn & Yahr stage, Unified Parkinson's Disease Rating Scale (UPDRS) scores, Mini Mental Status Examination (MMSE), and quantitative assessments of handwriting, bradykinesia, and hypophonia.
Main Results:
- Micrographia was identified in 63.2% of PD patients via history and 50% via handwriting tests.
- Micrographia ascertained by history significantly correlated with disease severity (Hoehn & Yahr), motor impairment (UPDRS), cognitive impairment (MMSE), bradykinesia, and hypophonia.
- Micrographia on handwriting tests correlated with age, MMSE scores, hypophonia, and bradykinesia.
Conclusions:
- Micrographia is prevalent in approximately half of the Parkinson's Disease cohort.
- Disease severity and cognitive impairment are significant clinical correlates of micrographia.
- The strong association with bradykinesia and hypophonia suggests potential shared pathophysiological mechanisms.
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