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Postural Instability and Cognitive Dysfunction in Early Parkinson's Disease

Published online by Cambridge University Press:  02 December 2014

Jong Moon Lee
Department of Neurology, Korea University College of Medicine
Seong-Beom Koh*
Department of Neurology, Korea University College of Medicine
Sung Won Chae
Department of Otolaryngology-Head and Neck Surgery, Korea University College of Medicine
Woo-Keun Seo
Department of Neurology, Korea University College of Medicine
Do Young Kwon
Department of Neurology, Korea University College of Medicine
Ji Hyun Kim
Department of Neurology, Korea University College of Medicine
Kyungmi Oh
Department of Neurology, Korea University College of Medicine
Jong Sam Baik
Department of Neurology, Sanggye Paik Hospital, Inje University College of Medicine, Seoul, Korea
Kun Woo Park
Department of Neurology, Korea University College of Medicine
Department of Neurology, Korea University College of Medicine Guro Hospital, #80 Guro-Dong, Guro-Ku, Seoul, Korea 152-703. e-mail:
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Postural instability is one of the most disabling features of Parkinson's disease, usually occurring in late and advanced stages. The aim of this study was to investigate the postural performance of early-stage de novo Parkinson's disease patients with no clinical postural instability using computerized dynamic posturography. We sought to understand the relationship between postural sway and disease severity and the relationship between postural instability quantitatively measured by computerized dynamic posturography and cognitive impairment in early-stage Parkinson's disease patients.


Thirty-one subjects with Parkinson's disease and 20 healthy controls were assessed by the computerized dynamic posturography protocol using the sensory organization test and the motor control test. A neuropsychological assessment was also administered.


The mean equilibrium score for sensory organization test and the vestibular input ratio were significantly correlated with Hoehn-Yahr stage. No associations between motor latency for any motor control test condition and Hoehn-Yahr stage were found. The equilibrium score for sensory organization test correlated with the mini-mental status examination scores. There was a significant correlation between motor latency for large backward translation and mini-mental status examination scores. There were significant correlations between visual perception/construction/ memory of the neuropsychological battery test and the equilibrium score for sensory organization test and between verbal word learning test, controlled word association test and motor latency for large backward translation.


These findings showed the postural instability present in early-stage (Hoehn-Yahr stage 2-2.5) Parkinson's disease. We also found a close relationship between postural instability and cognitive function in Parkinson's disease patients.

Original Article
Copyright © The Canadian Journal of Neurological 2012


1.Hoehn, MM, Yahr, MD.Parkinsonism: onset, progression and mortality. Neurology. 1967 May;17(5):42742.Google Scholar
2.Boonstra, TA, van der Kooij, H, Munneke, M, Bloem, BR.Gait disorders and balance disturbances in Parkinson’s disease: clinical update and pathophysiology. Curr Opin Neurol. 2008 Aug;21(4):46171.Google Scholar
3.Grimbergen, YA, Munneke, M, Bloem, BR.Falls in Parkinson’s disease. Curr Opin Neurol. 2004 Aug;17(4):40515.Google Scholar
4.Bloem, BR.Postural instability in Parkinson’s disease. Clin Neurol Neurosurg. 1992;94 Suppl: S415.Google Scholar
5.Benatru, I, Vaugoyeau, M, Azulay, JP.Postural disorders in Parkinson’s disease. Neurophysiol Clin. 2008 Dec;38(6):45965.Google Scholar
6.Bloem, BR, Grimbergen, YA, Cramer, M, Willemsen, M, Zwinderman, AH.Prospective assessment of falls in Parkinson’s disease. J Neurol. 2001 Nov;248(11):9508.Google Scholar
7.Munhoz, RP, Li, JY, Kurtinecz, M, et al.Evaluation of the pull test technique in assessing postural instability in Parkinson’s disease. Neurology. 2004 Jan 13;62(1):1257.Google Scholar
8.Visser, M, Marinus, J, Bloem, BR, Kisjes, H, van den Berg, BM, van Hilten, JJ.Clinical tests for the evaluation of postural instability in patients with parkinson’s disease. Arch Phys Med Rehabil. 2003 Nov;84(11):166974.Google Scholar
9.Furman, JM.Posturography: uses and limitations. Baillieres Clin Neurol. 1994 Nov;3(3):50113.Google Scholar
10.Artuso, A, Garozzo, A, Contucci, AM, Frenguelli, A, Di Girolamo, S.Role of dynamic posturography (Equitest) in the identification of feigned balance disturbances. Acta Otorhinolaryngol Ital. 2004 Feb;24(1):812.Google Scholar
11.Waterston, JA, Hawken, MB, Tanyeri, S, Jantti, P, Kennard, C.Influence of sensory manipulation on postural control in Parkinson’s disease. J Neurol Neurosurg Psychiatry. 1993 Dec;56(12):127681.Google Scholar
12.Frenklach, A, Louie, S, Koop, MM, Bronte-Stewart, H.Excessive postural sway and the risk of falls at different stages of Parkinson’s disease. Mov Disord. 2009 Feb 15;24(3):37785.Google Scholar
13.Valkovic, P, Krafczyk, S, Botzel, K.Postural reactions to soleus muscle vibration in Parkinson’s disease: scaling deteriorates as disease progresses. Neurosci Lett. 2006 Jun 19;401(1-2):926.Google Scholar
14.Valkovic, P, Abrahamova, D, Hlavacka, F, Benetin, J.Static posturography and infraclinical postural instability in early-stage Parkinson’s disease. Mov Disord. 2009 Aug 15;24(11):17134; author reply 4.Google Scholar
15.Chastan, N, Debono, B, Maltete, D, Weber, J.Discordance between measured postural instability and absence of clinical symptoms in Parkinson’s disease patients in the early stages of the disease. Mov Disord. 2008 Feb 15;23(3):36672.Google Scholar
16.Fioretti, S, Guidi, M, Ladislao, L, Ghetti, G.Analysis and reliability of posturographic parameters in Parkinson patients at an early stage. Conf Proc IEEE Eng Med Biol Soc. 2004;1:6514.Google Scholar
17.Lang, AE, Obeso, JA.Challenges in Parkinson’s disease: restoration of the nigrostriatal dopamine system is not enough. Lancet Neurol. 2004 May;3(5):30916.Google Scholar
18.Rocchi, L, Chiari, L, Horak, FB.Effects of deep brain stimulation and levodopa on postural sway in Parkinson’s disease. J Neurol Neurosurg Psychiatry. 2002 Sep;73(3):26774.Google Scholar
19.Bronte-Stewart, HM, Minn, AY, Rodrigues, K, Buckley, EL, Nashner, LM.Postural instability in idiopathic Parkinson’s disease: the role of medication and unilateral pallidotomy. Brain. 2002 Sep;125(Pt9):210014.Google Scholar
20.Jankovic, J, McDermott, M, Carter, J, et al.Variable expression of Parkinson’s disease: a base-line analysis of the DATATOP cohort. The Parkinson Study Group. Neurology. 1990 Oct;4 0(10):152934.Google Scholar
21.Alves, G, Larsen, JP, Emre, M, Wentzel-Larsen, T, Aarsland, D.Changes in motor subtype and risk for incident dementia in Parkinson’s disease. Mov Disord. 2006 Aug;21(8):112330.Google Scholar
22.Burn, DJ, Rowan, EN, Allan, LM, Molloy, S, O’Brien, JT, McKeith, IG.Motor subtype and cognitive decline in Parkinson’s disease, Parkinson’s disease with dementia, and dementia with Lewy bodies. J Neurol Neurosurg Psychiatry. 2006 May;77(5):5859.Google Scholar
23.Gago, MF, Garrett, MC, Fonseca, MR, et al.How do cognitive and axial motor signs correlate in Parkinson’s disease? A 6-year prospective study. J Neurol. 2009 Oct;256(10):165562.Google Scholar
24.Levy, G, Tang, MX, Cote, LJ, et al.Motor impairment in PD: relationship to incident dementia and age. Neurology. 2000 Aug 22;55(4):53944.Google Scholar
25.Lyros, E, Messinis, L, Papathanasopoulos, P.Does motor subtype influence neurocognitive performance in Parkinson’s disease without dementia? Eur J Neurol. 2008 Mar;15(3):2627.Google Scholar
26.Oh, JY, Kim, YS, Choi, BH, Sohn, EH, Lee, AY.Relationship between clinical phenotypes and cognitive impairment in Parkinson’s disease (PD). Arch Gerontol Geriatr. 2009 Nov-Dec;4 9(3):3514.Google Scholar
27.Williams, LN, Seignourel, P, Crucian, GP, et al.Laterality, region, and type of motor dysfunction correlate with cognitive impairment in Parkinson’s disease. Mov Disord. 2007 Jan;22(1):1415.Google Scholar
28.Nashner, LM.Practical management of the dizzy patient. In: Goebel, JA, editor. Computerized dynamic posturography. Philadelphia; 2001. p. 14370.Google Scholar
29.Nashner, LM, Shupert, CL, Horak, FB, Black, FO.Organization of posture controls: an analysis of sensory and mechanical constraints. Prog Brain Res. 1989;80:4118; discussion 395-7.Google Scholar
30.Hamid, MA, Hughes, GB, Kinney, SE.Specificity and sensitivity of dynamic posturography. A retrospective analysis. Acta Otolaryngol Suppl. 1991;481:596600.Google Scholar
31.Horak, FB, Nashner, LM.Central programming of postural movements: adaptation to altered support-surface configurations. J Neurophysiol. 1986 Jun;55(6):136981.Google Scholar
32.Ahn, HJ, Chin, J, Park, A, et al.Seoul Neuropsychological Screening Battery-dementia version (SNSB-D): a useful tool for assessing and monitoring cognitive impairments in dementia patients. J Korean Med Sci. Jul;25(7):10716.Google Scholar
33.Ondo, W, Warrior, D, Overby, A, et al.Computerized posturography analysis of progressive supranuclear palsy: a case-control comparison with Parkinson’s disease and healthy controls. Arch Neurol. 2000 Oct;57(10):14649.Google Scholar
34.Rossi, M, Soto, A, Santos, S, Sesar, A, Labella, T.A prospective study of alterations in balance among patients with Parkinson’s Disease. Protocol of the postural evaluation. Eur Neurol. 2009;61(3):1716.Google Scholar
35.Azulay, JP, Mesure, S, Amblard, B, Blin, O, Sangla, I, Pouget, J.Visual control of locomotion in Parkinson’s disease. Brain. 1999 Jan;122(Pt 1):11120.Google Scholar
36.Isableu, B, Ohlmann, T, Cremieux, J, Amblard, B.Selection of spatial frame of reference and postural control variability. Exp Brain Res. 1997 May;114(3):5849.Google Scholar
37.Pastor, MA, Day, BL, Marsden, CD.Vestibular induced postural responses in Parkinson’s disease. Brain. 1993 Oct;116(Pt 5):117790.Google Scholar