AUTHOR=Yu Xin , Jiang Hong-ying , Zhang Chen-xi , Jin Zhao-hui , Gao Lei , Wang Rui-dan , Fang Jin-ping , Su Yuan , Xi Jia-ning , Fang Bo-yan 

TITLE=The Role of the Diaphragm in Postural Stability and Visceral Function in Parkinson’s Disease

JOURNAL=Frontiers in Aging Neuroscience

VOLUME=Volume 13 - 2021

YEAR=2021

URL=https://www.frontiersin.org/journals/aging-neuroscience/articles/10.3389/fnagi.2021.785020

DOI=10.3389/fnagi.2021.785020

ISSN=1663-4365

ABSTRACT=Background: In normal subjects, the diaphragm plays a key functional role in postural stability, articulation, respiration, defecation, and urination. Objectives: The aim of this study was to investigate the role of the diaphragm in postural stability and visceral function in patients in Parkinson's disease (PD) and compare diaphragm function by gender, Hoehn and Yahr staging and motor subtypes. Methods: 79 patients were enrolled in this cross-sectional study. The severity of the disease was assessed by the Movement Disorder Society-Unified Parkinson’s Disease Rating Scale Ⅲ and by H&Y staging. Postural stability was quantitatively recorded and respiratory function was evaluated by spirometry. Several scales were used to evaluate visceral function in patients with PD. In addition, diaphragm ultrasound was used to measure the excursion, contraction velocity, and thickness of diaphragm during quiet breathing, deep breathing, and the sniff test. Significant features were selected by LASSO (least absolute shrinkage and selection operator) regression and fitted in multivariate linear regression and Pearson’s correlation analysis. Results: Diaphragm thickness and excursion during quiet breathing was significantly different between male and female and between H&Y stage 1-2 and stage 2.5-3, whereas diaphragm function was not influenced by motor subtypes. It is showed that diaphragmatic function was significant correlated with postural stability, voice function, respiratory function, constipation, and urological function to varying degrees in patients with PD.  Conclusions: Diaphragmatic function is associated with dysfunction in PD although it remains unclear as to whether the observed changes in the diaphragm are primary or secondary.