Clinical correlates of anterior and lateral flexion of the thoracolumbar spine and dropped head in patients with Parkinson's disease

Introduction: Parkinson's disease (PD) is often accompanied by postural disorders such as anterior and lateral flexion of the thoracolumbar spine and dropped head. We examined frequencies and clinical correlates of postural disorders in patients with PD. Methods: We interviewed 365 consecutive PD patients between 40 and 80 years of age, at Hoehn and Yahr stages 1, 2, 3 and 4, and evaluated postural deformities, including anterior and lateral flexion of the trunk and dropped head as well as other clinical characteristics. Control subjects were 65 age-matched patient spouses without neurological or spinal disorders. Results: There were no differences in age or sex between PD patients and controls. The frequencies of anterior and lateral flexion of the trunk were significantly higher in PD patients than in controls. The frequency and severity of anterior and lateral flexion and the incidence of dropped head increased as the disease progressed. Other factors related to anterior and lateral flexion included age, disease duration, lower MMSE score, lumbago and levodopa equivalent daily dose of dopaminergic drugs. Women tended to develop more severe anterior flexion than men. Anterior flexion severity also correlated with that of lateral flexion and the emergence of dropped head. Conclusions: Postural disorders are frequent complications in PD patients and their severity increases with disease progression. Advancing age and disease severity may be the major risks for developing postural disorders. (C) 2011 Elsevier Ltd. All rights reserved.