Motor complications and postural abnormalities interplay in Parkinson's disease

Postural abnormalities (PA) and motor complications (MCs, including motor fluctuations - MFs- and levodopa-induced dyskinesia - LIDs) are hallmark of Parkinson's disease (PD) progression, yet their relationship remains poorly understood.

To investigate the association between PA and MCs, motor symptoms, and non-motor symptoms (NMS) in patients with PD, and to assess whether PA influences the development of MCs over time.

Data of the prospective NS-Park cohort (27 French PD Expert Centers) were analysed. PA was defined by a score ≥2 on item 3.13 of the MDS-UPDRS-III. Associations between PA and MCs, as well as with other motor symptoms and NMS, were assessed using logistic regression models. We used interval censoring survival models to assess the associations between PA at inclusion and the incidence of MCs. Analyses were adjusted for sex, age, disease duration, dopaminergic dose, and disease severity.

Among 13,037 included PD patients (58.7 % male, median age at diagnosis 61 years), 724 (5.6 %) presented with PA. Patients with PA had longer disease duration, higher disease severity, and higher dopaminergic treatment. PA exhibited a higher prevalence of troublesome MFs (OR: 5.96; 95 % CI: 4.25-8.32) and LIDs (OR: 2.81; 95 % CI: 1.79-4.30), while associations with milder MCs were inconsistent. However, PA was not significantly associated with the development of MCs during follow-up.

PA are associated with more frequent severe MCs, and a higher burden of motor and NMS, making patient care particularly challenging.