Analysis Of Clinical Features,Serological Indicators And Bone Mineral Density In Patients With Parkinson’s Disease And Camptocormia

Background:Parkinson’s disease(PD)is a common neurodegenerative disease that severely affects the quality of life of patients and imposes a huge economic burden on families and society.Postural abnormalities are disabling motor complications.Camptocormia(CC)is one of the most common postural abnormalities in PD patients,which occurs at different stages of the disease,interferes with the patients’ activities of daily living,and leads to severe disability and fall episodes.The combination of CC further exacerbates motor impairment in PD patients,severely affecting their ability to perform activities of daily living and their quality of life.Objective:To investigate the clinical characteristics of PD patients with CC and the factors affecting camptocormia,so as to provide reference for the possible pathogenesis of CC.Methods:1.PD patients who visited the Department of Neurology,Qilu Hospital of Shandong University from January 2022 to December 2022 were collected.Based on the medical history(the description of camptocormia)and the Movement Disorder Society Unified Parkinson’s Disease Rating Scale(MDS-UPDRS)indicates whether the score of posture abnormalities(3.13 items)was≥2 points,the patients were divided into PD with camptocormia group and PD without camptocormia group(PD-CC group and PD-nCC group).General information of PD patients,including gender,age,education level,type of residence(coastal/non-coastal),history of gas poisoning,family history,height,weight and body mass index(BMI)were collected.Disease information includes age of onset,duration,site of onset,disease type,current stable medication regimen,and levodopa equivalent daily doses(LEDDs)were calculated.Supine and orthostatic blood pressure were measured and the corresponding scales were assessed,include MDS-UPDRS,Hoehn-Yahr stage,Mini-mental state examination(MMSE),Montreal cognitive assessment(MoCA),Hamilton depression rating scale(HAMD),Hamilton anxiety rating scale(HAMA),Non-Motor Symptoms Scale(NMSS),The Parkinson’s Disease Questionnaire(PDQ-39),Parkinson’s Disease Sleep Scale(PDSS),The Epworth Sleeping Scale(ESS).The general information and clinical parameters of PD-CC and PD-nCC patients were studied in comparison.2.Some of the patients completed routine blood tests,erythrocyte sedimentation rate(ESR),hypersensitive C-reactive protein(hs-CRP),uric acid(UA),25-hydroxyvitamin D(25OH-D)and bone mineral density(BMD),and the data were analyzed between groups in PDCC and PD-nCC.The data of 25-OH-D and BMD were analyzed between groups after gender stratification.3.The variables that were statistically significant in the univariate analysis were included,and further binary logistic regression analysis was performed to establish a regression model for factors influencing the occurrence of camptocormia in PD patients.And the validity of the regression model was verified by applying the receiver operating characteristic(ROC)curve and the area under the curve(AUC).4.The standing lateral whole-body photos of patients with CC were taken and the bend position and angle of the spine were measured using NeuroPostureApp.According to the measurement results,PD-CC were divided into upper camptocormia(UCC)and lower camptocormia(LCC),and the differences of clinical and examination indicators between the two groups were analyzed.Results:1.A total of 212 PD patients were included in this study,in which all male aged 50 years or older and all female are postmenopausal(male/female:98/114),with an average age of 64.86±8.8 years.There were 57 cases of PD-CC(male/female:24/33)and 155 cases of PDnCC(male/female:74/81).There were no significant differences between PD-CC and PDnCC groups in terms of gender,education level,number of coastal population,history of gas poisoning and family history of PD.The age of PD-CC group was significantly higher than that of PD-nCC group,while the BMI of PD-CC group was lower than that of PD-nCC group(P<0.05).2.Analysis between PD-CC and PD-nCC groups showed a difference in the site of onset(P<0.05),and the upper extremity site of onset was more common in PD-CC group than in PD-nCC group.Compared with PD-nCC,PD-CC had longer disease duration,more severe disease(H-Y staging),and higher scores of motor symptoms(MDS-UPDRS Ⅱ and Ⅲ)and non-motor symptoms(MDS-UPDRS Ⅰ,NMSS),lower scores of cognitive function(MMSE,MoCA)and quality of life(PDQ-39),more severe daytime sleepiness,and more comorbid lumbago and back pain.Meanwhile,patients in PD-CC group had a higher level of LEDDs use,and the number of patients using levodopa,dopamine agonists and amantadine was higher than that in PD-nCC group(P<0.05).There were no significant difference in the age of onset,diagnostic classification,type of first symptoms,number of patients with orthostatic hypotension(OH),olfactory level,HAMA,HAMD,PDSS score,and the users number of MAO-BI,COMT-I,anticholinergic drugs between the two groups.3.Among the above subjects,71 PD patients completed the examination and CC/nCC:37/34.There were no significant differences in the number of red blood cell,white blood cell,neutrophil,lymphocyte,platelet,hemoglobin content,neutrophil/lymphocyte ratio,platelet/lymphocyte ratio,ESR,hs-CRP,UA level between the two groups.After sex subgroup analysis,there were no significant differences in the level of 25-OH-D,the proportion of osteoporosis and T value at each site of lumbar vertebrae and left hip between PD-CC and PD-nCC groups.4.Binary logistic regression analysis incorporating the above meaningful factors.The results showed that the older the age(OR=1.108),combined with lumbago and back pain(OR=3.155),the higher the use of LEDDs(OR=1.004)and the higher the motor score(MDSUPDRS Ⅲ)(OR=1.068),the higher the risk of camptocormia in PD patients,and the differences were statistically significant(P<0.05).The receiver operating characteristic(ROC)curve was plotted according to the regression model,yielding an area under the curve(AUC)of 0.850 with a standard error of 0.027 and 95%CI of(0.796,0.904),P<0.001.5.Patients in the PD-CC group who completed the examination were divided into UCC and LCC(UCC/LCC:10/22)according to the lateral body photos taken and the different parts of the spine curvature.The analysis showed that there were no significant differences in gender,clinical scale scores and laboratory reports between the two groups.Bone mineral density results showed that the T-value of both lumbar spine and left hip were lower in the UCC group than in the LCC group,and the differences were statistically significant(P<0.01).Conclusion:1.PD-CC patients had more severe clinical symptoms than PD-nCC patients,and the presence of CC in PD patients was associated with advanced age,combined lumbago and back pain,high motor scores,and high levodopa equivalent doses.2.No differences were found in neutrophil/lymphocyte ratio,platelet/lymphocyte ratio,ESR,hs-CRP levels between PD-CC and PD-nCC patients.After sex subgroup analysis,no difference was found in the level of 25-OH-D between PD-CC and PD-nCC,as well as in the number of osteoporosis patients and the degree of osteoporosis.3.Lower BMD levels in the lumbar spine and left hip may be associated with lower BMI in UCC patients compared with LCC patients.