Cogwheel rigidity in Parkinson's disease: Clinical, biomechanical and neurophysiological features

Abstract

OBJECTIVES: Cogwheel rigidity in Parkinson's disease has been poorly investigated so far, thus leaving the scientific interpretation of this phenomenon substantially unsolved. A detailed clinical, biomechanical and neurophysiological investigation would clarify the pathophysiological underpinning of cogwheel rigidity. METHODS: Patients underwent robot-assisted wrist extensions at various angular velocities, when OFF and ON therapies. For each value of angular velocity, several biomechanical (i.e. elastic, viscous and neural components) and neurophysiological measures (i.e. long-latency stretch reflex) were synchronously assessed and correlated with the clinical score of rigidity (i.e. Movement Disorder Society Unified Parkinson's Disease Rating Scale-part III, subitems for the upper limb). RESULTS: A total of 18 PD patients participated. Patients were divided into two groups according to the presence of cogwheel rigidity at the clinical examination (CWR and No-CWR, respectively). CWR patients had a longer disease duration, greater motor severity and disability scores compared to those who did not. Biomechanical (NC and TF) and neurophysiological data (LLRs amplitude and AUC) also disclosed a more pronounced impairment in patients with cogwheel rigidity. L-DOPA comparably improved rigidity measures in patients with and without cogwheel rigidity. DISCUSSION: Cogwheel rigidity may be associated with prominent impairment in clinical, biomechanical, and neurophysiological features of rigidity in patients with PD. Future studies in larger cohorts are needed to achieve more firm conclusions.