Correlation between cognitive/emotional factors and postural control in patients with Parkinson's disease

Introduction: Cognition and emotional state are domains that highly interfere with postural control in Parkinson's disease (PD) patients. Objective: This study aims to find associations between executive function, anxiety, depression, and reactive and anticipatory postural control domains. Methods: In this cross-sectional study, thirty-four PD patients were thoroughly assessed for postural control in perturbed, quiet standing, and stepping initiation. To measure the postural response (PR), participants had to recover a stable balance of orthostatic posture in response to backward translation of the support base. The Ethics Committee of the School of Physical Educations and Sport of the University of São Paulo approved the study protocol. To measure anticipatory postural adjustments (APA), participants took a step initiation by moving their right foot after a beep. The following scales were performed: Montreal Cognitive Assessment (MoCA), Frontal Assessment Battery (FAB), Stroop test part III (Stroop-III), Digit Symbol Substitution Test (DSST), Trail Making Test B (TMTB), Hospital Anxiety and Depression Scale (HADS) has two subscales, the Hospital Anxiety Scale (HAS) and the Hospital Depression Scale (HDS). Spearman's correlation coefficients were calculated between the clinical scales and postural tasks, controlled by disease duration and levodopa dosage. We performed multiple linear stepwise regression using postural variables as dependent and cognitive/emotional as independent variables. Results: Stroop-III showed a significant correlation with APA duration (rho = 0.46, p = 0.009) and area of quiet standing (QS) in rigid surface (RS) (rho = 0.48, p = 0.005) and malleable surface (MS) (rho = 0.63, p < 0.001). HAS showed a significant correlation with APA duration (rho = 0.51, p = 0.003), and amplitude of PR (rho = 0.61, p < 0.001). HDS showed a significant correlation with amplitude of PR (rho = 0.62, p < 0.001) [Figure 1]. Conclusion: Our results highlight the impact of emotional and cognitive states on particular domains of postural control in patients with PD. These results may have significant implications for targeting future treatments, mainly considering the predictors for postural control domains, which were consistent with the assumption that impairments in affective and executive domains underlie posture.