Original research| Volume 101, ISSUE 9, P1580-1589, September 2020

Association Between Motor Subtype and Visuospatial and Executive Function in Mild-Moderate Parkinson Disease

  • Hannah Lally
    Emory College of Arts and Sciences, Atlanta, Georgia
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  • Ariel R. Hart
    Department of Medicine, Division of General Medicine and Geriatrics, Emory University School of Medicine, Atlanta, Georgia
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  • Allison A. Bay
    Department of Medicine, Division of General Medicine and Geriatrics, Emory University School of Medicine, Atlanta, Georgia
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  • Chaejin Kim
    Emory University Rollins School of Public Health, Atlanta, Georgia
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  • Steven L. Wolf
    Department of Medicine, Division of General Medicine and Geriatrics, Emory University School of Medicine, Atlanta, Georgia

    Department of Rehabilitation Medicine, Division of Physical Therapy, Emory University School of Medicine, Atlanta, Georgia

    Department of Cell Biology, Emory University School of Medicine, Atlanta, Georgia

    Atlanta VA Center for Visual and Neurocognitive Rehabilitation, Decatur, Georgia
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  • Madeleine E. Hackney
    Corresponding author Madeleine E. Hackney, PhD, Department of Medicine, Division of General Medicine and Geriatrics, Emory University School of Medicine, 1841 Clifton Rd NE, #553, Atlanta, GA, 30329.
    Department of Medicine, Division of General Medicine and Geriatrics, Emory University School of Medicine, Atlanta, Georgia

    Department of Rehabilitation Medicine, Division of Physical Therapy, Emory University School of Medicine, Atlanta, Georgia

    Atlanta VA Center for Visual and Neurocognitive Rehabilitation, Decatur, Georgia
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      To compare participants with Parkinson disease (PD) motor subtypes, postural instability and gait difficulty (PIGD) (n=46) and tremor dominant (TD) (n=28), in cognitive and motor-cognitive assessments with the purpose of identifying associations between subtype and visuospatial, whole-body spatial, inhibition and/or switching, and planning and/or organizational aspects of cognitive and motor-cognitive function.


      Retrospective cohort study. Fisher exact test was used for categorical variables, while 2-sample independent t tests were used to analyze continuous variables.


      Assessments took place at Emory University.


      Participants (N=72) were 40 years and older, had a clinical diagnosis of PD, exhibited 3 of the 4 cardinal signs of PD, had shown benefit from antiparkinsonian medications, and were in Hoehn and Yahr stages I-IV. Participants could walk 3 m or more with or without assistance.


      Not applicable.

      Main Outcome Measures

      Balance and mobility tests included Fullerton Advanced Balance Scale and the time needed to turn 360 degrees. Cognitive assessments included Montreal Cognitive Assessment, Brooks Spatial Memory Task, Color-Word Interference Test, Tower of London, Trail Making Test, Corsi Blocks, Serial 3s Subtraction, and Body Position Spatial Task. Motor-cognitive function measures included Four Square Step Test and Timed Up and Go.


      Participants with PIGD performed lower than those with TD symptoms on mental status (P=.005), spatial memory (P=.027), executive function (P=.0001-.034), and visuospatial ability (P=.048).


      Findings suggest that PIGD subtype is linked to greater deficits in spatial cognition, attentional flexibility and organizational planning, and whole-body spatial memory domains. These findings support the need for more personalized approaches to clinically managing PD.


      List of abbreviations:

      ADL (activities of daily living), BPST (Body Position Spatial Task), CPF (Composite Physical Function), CWIT (Color-Word Interference Test), FAB (Fullerton Advanced Balance Scale), FSST (Four Square Step Test), MDS-UPDRS (Movement Disorders Society Unified Parkinson’s Disease Rating Scale), MoCA (Montreal Cognitive Assessment), PD (Parkinson disease), PIGD (postural instability and gait difficulty), TD (tremor dominant), TOL (Tower of London), TUG (Timed Up and Go)
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