Predictors of Pisa syndrome in Chinese patients with Parkinson's disease: A prospective study

Abstract

Introduction: Pisa Syndrome (PS) is a disabling complication in Parkinson's disease (PD) with unclear pathogenesis, yet studies on the longitudinal observation of PS are absent. This study aims to investigate the clinical predictors of PS from a cohort of Chinese PD patients.

Methods: A total of 373 PD patients without PS were prospectively monitored for approximately 2.5 years. Demographic and clinical data were investigated. A penalized logistic regression model was conducted to discriminate the predictive factors of PS.

Results: Overall, PS was observed in 22 patients (5.9%) during the study period. At baseline, the following variables including Unified PD Rating Scale (UPDRS) part III score, the axial subscore of UPDRS part III, the modified Hoehn and Yahr (H&Y) stage, the subscore "taste or smell" of the Non-Motor Symptoms Scale (NMSS), proportion of males and rapid eye movement sleep behavior disorder (RBD), were significantly higher in patients with PS compared to those without PS (p < 0.05). The multivariable penalized logistic regression model indicated that the presence of RBD (OR = 4.088, p = 0.003) and higher axial subscore of UPDRS part III (OR = 1.196, p = 0.002) predicted a higher risk of developing PS.

Conclusion: PD patients with RBD and more severe axial symptoms are more likely to develop PS in the future.

Keywords: Axial symptoms; Parkinson's disease; Pisa syndrome; Rapid eye movement sleep behavior disorder.