Ten-Second Cold Water Stress Test Differentiates Parkinson's Disease from Multiple System Atrophy: A Cross-Sectional Pilot Study

Abstract

Background/Objectives: Patients with Parkinson's disease (PD) often have cold hands and experience frostbite. The diagnostic criteria for multiple system atrophy (MSA) also describe cold and discolored hands; however, in our clinical experience, the hands are relatively warm. These symptoms are thought to be caused by autonomic dysfunction; however, the detailed mechanisms and differences in cold hands between MSA and PD remain unclear. We aimed to identify an appropriate cold stimulation test to differentiate patients with PD and MSA using finger surface temperature (FST). Methods: We included a total of 34 patients, 27 with PD and 7 with MSA diagnosed at least 5 years after disease onset. After 15 min in a room with constant temperature and humidity, the patient's hand was placed in cold water at 4 °C for 10 s as the cold water stress test (10sec-CWST). FST was captured using a thermal imaging camera every minute for 15 min, and the recovery of FST was analyzed. The association between the clinical characteristics of each patient and the degree of FST recovery was examined. Results: All patients completed the 10sec-CWST without adverse events. Patients with PD showed a significantly slower recovery of FST after 7 min compared to those with MSA, with a maximum difference at 11 min (PD: 8.1 ± 0.6 °C; MSA: 10.5 ± 0.3 °C; p < 0.01). FST recovery at 11 min was negatively correlated with the degree of resting hand tremor (r = -0.585, p < 0.01). Conclusions: FST after 10sec-CWST may be a safe and efficient test to differentiate PD and MSA.

Keywords: Parkinson’s disease; cold stress test; multiple system atrophy; surface temperature; thermography.

Figure 1

Typical images of finger surface temperature (FST) changes over time in a patient with Parkinson’s disease (PD) and one with multiple system atrophy (MSA). FST in PD (case 26) rarely recovers, while it shows rapid improvement in MSA (case 4). CWST, cold water stress test; MSA-C, multiple system atrophy—cerebellar subtype; PD, Parkinson’s disease.

Figure 2

The change in FST over time for the PD and MSA groups. The PD group shows slower FST recovery than that of the MSA group, with a statistically significant difference after 7 min of stimulation (maximal difference after 11 min). FST, finger surface temperature; MSA, multiple system atrophy; PD, Parkinson’s disease; SE, standard error.

Figure 3

Receiver operating characteristic curves in PD and MSA differentiated by FST recovery after 11 min of stimulation. A cutoff value of 9.6 °C gives a sensitivity of 70.6%, specificity of 85.7%, and maximum area under the curve of 0.786. AUC, area under the curve; CI, confidence interval.

Figure 4

Correlation between recovery of FST after 11 min of cold stimulation and resting tremor/olfactory score. In all patients, there is a significant correlation between FST and resting tremor/olfaction scores, but only resting tremor is statistically significant in the PD group. FST, finger surface temperature; MSA, multiple system atrophy; OSIT-J, odor stick identification test for the Japanese; PD, Parkinson’s disease; UPDRS, Unified Parkinson’s Disease Rating Scale.