Clinical Definition of Camptocormia in Parkinson's Disease

Abstract

Background: Clinical key aspects of camptocormia in patients with idiopathic Parkinson's disease (PD) await further definition.

Methods: Based on a self-assessment of PD patients, we performed an observational study, asking patients with subjectively felt involuntary forward bending to return a questionnaire and provide photographs showing their axial disorder. Forty-two matched PD patients without subjective signs of camptocormia were recruited as controls.

Results: The stooped posture of patients with advanced PD without camptocormia is characterized by a forward bending angle of always less than 30 degrees. Of the 145 camptocormia patients in our study, 70% had an angle ≥30 degrees. The patients with a more-severe forward bending angle were more severely affected in daily life than those with an angle of less than 30 degrees. Back pain was more frequent (81% vs. 43%) and more severe in PD patients with camptocormia than in controls. Back diseases in camptocormia PD patients were also significantly more frequent than in the PD control patients (55% vs. 26%). Camptocormia is a relevant burden in everyday life. Seventy-seven percent of patients needed walking aids and 85% reported specific disabilities attributed to camptocormia (e.g. increased risk of falling, dyspnea, problems in eating or swallowing).

Conclusions: Camptocormia cannot be clinically defined based on the forward bending angle alone, but an angle larger than 30 degrees is only found in camptocormia. Back pain is an essential aspect of camptocormia in PD. Back diseases can be seen as a risk factor in these patients.

Keywords: back pain; bent spine syndrome; camptocormia; idiopathic Parkinson's disease; postural abnormality; stooped posture.

Figure 1

(A) Method of angle assessment. (B) Camptocormia angle in the control group (gray) and photo‐documented questionnaire patients complaining of camptocormia (black). It is evident that there is a (sub)group that can clearly be separated from PD patients without the subjective complaint of camptocormia and another (sub)group of PD patients with the subjective complaint of camptocormia, but who have a forward bending angle similar to the control PD patients without camptocormia.

Figure 2

Flow chart showing the classification of the returned questionnaires and the definition of subgroups.

Figure 3

(A) Frequency of back pain, (B) localization of back pain, (C) frequency of back diseases for ≥30‐degree camptocormia patients, the overlap (<30 degrees), and control group patients. (D) Need of walking aids in ≥30‐degree camptocormia patients and the overlap (<30‐degree) group.