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Neurology
Research
Micrographia and related deficits in Parkinson's disease: a cross-sectional study
  1. Aparna Wagle Shukla1,
  2. Songthip Ounpraseuth2,
  3. Michael S Okun1,
  4. Vickie Gray3,
  5. John Schwankhaus3,
  6. Walter Steven Metzer3
  1. 1Department of Neurology, University of Florida, Center for Movement Disorders and Neurorestoration, Gainesville, Florida, USA
  2. 2Department of Biostatistics, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
  3. 3Department of Neurology, University of Arkansas for Medical Sciences and the Central Arkansas Veterans Healthcare System (CAVHS), Little Rock, Arkansas, USA
  1. Correspondence to Dr Aparna Wagle Shukla; aparna.shukla{at}neurology.ufl.edu

Abstract

Objectives To determine the prevalence and clinical features associated with micrographia in Parkinson's Disease (PD).

Setting This study was conducted at a Movement Disorders clinic located in a Veteran Administration Hospital.

Participants PD subjects were included only if they satisfied UK Parkinson's Disease Society criteria for diagnosis. Subjects with history of severe tremors, dystonia, dyskinesia, strokes, peripheral neuropathy and dementia were excluded.

Design This was a case–control study where PD subjects were prospectively enrolled and their demographics, Hoehn & Yahr stage, Unified Parkinson's Disease Rating Scale and Mini Mental Status examination (MMSE) scores were recorded. All subjects were specifically asked for micrographia on history and the handwritings were quantitatively documented. Bradykinesia was determined by history and quantified by a finger tap, Purdue pegboard and a timed walk test. Similarly, hypophonia was determined by history and the volume of speech quantified using a decibel meter. Controls were enrolled for validation of handwriting test scores and decibel meter recordings.

Primary outcome measures Prevalence of micrographia in the PD cohort and the clinical factors that correlate with micrographia.

Results 68 subjects with PD were enrolled (68 men; mean age 72.3 years). Micrographia was identified in 63.2% of the cohort on verbal history and in 50% of the cohort when the handwriting test was used for ascertainment. Micrographia ascertained on history correlated significantly with disease severity (Hoehn & Yahr stage), motor impairment (Unified Parkinson's Disease Rating Scale), cognitive impairment (MMSE) and both bradykinesia and hypophonia determined by history and quantitative testing. Micrographia on handwriting test correlated with age (p=0.02), MMSE testing (p=0.04), hypophonia by history (p=0.01) and bradykinesia by quantitative testing (p=0.04).

Conclusion Micrographia was found in nearly half of the PD cohort. Disease severity and impaired cognition were important clinical correlates. Micrographia had a significant relationship with bradykinesia and hypophonia, suggesting a possible overlap in their pathophysiology.

This is an open-access article distributed under the terms of the Creative Commons Attribution Non-commercial License, which permits use, distribution, and reproduction in any medium, provided the original work is properly cited, the use is non commercial and is otherwise in compliance with the license. See: http://creativecommons.org/licenses/by-nc/2.0/ and http://creativecommons.org/licenses/by-nc/2.0/legalcode.

https://doi.org/10.1136/bmjopen-2011-000628

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    Footnotes

    • To cite: Wagle Shukla A, Ounpraseuth S, Okun MS, et al. Micrographia and related deficits in Parkinson's disease: a cross-sectional study. BMJ Open 2012;2:e000628. doi:10.1136/bmjopen-2011-000628

    • Contributors AWS was involved in conception and design, acquisition of data, interpretation of data, drafting the article and final approval of the version; SO was involved in interpretation of data, drafting the article and final approval of the version; MSO, VG and JS were involved in revising the article critically for important intellectual content and final approval of the version to be published. SWM was involved in conception and design, acquisition of data, drafting the article and final approval of the version.

    • Funding This research received no specific grant from any funding agency in public, commercial or not-for-profit sectors.

    • Competing interests MSO serves as a consultant for the National Parkinson's Foundation and has received research grants from NIH, NPF, the Michael J. Fox Foundation, the Parkinson's Alliance, Smallwood Foundation and the UF Foundation. MSO has in the past >24 months received no support from industry including travel. MSO has received royalties for publications with Demos, Manson and Cambridge (movement disorders books). MSO has participated in CME activities on movement disorders sponsored by the USF CME office, Peer View and by Vanderbilt University. The institution and not MSO receives grants from Medtronic and ANS/St. Jude, and the PI has no financial interest in these grants. MSO has participated as a site PI and/or co-investigator for several NIH, foundation and industry-sponsored trials over the years but has not received honoraria. VG: employment—Central Arkansas Veterans Health Care System; JS: employment—Central Arkansas Veterans Health Care System; SWM: employment—Central Arkansas Veterans Health Care System.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Data sharing statement There are no additional data to share.