Spinocerebellar Degeneration Patients Research Articles

Roles of the cerebellum and basal ganglia in temporal integration: Insights from a synchronized tapping task

ObjectiveThe aim of this study was to clarify the roles of the cerebellum and basal ganglia for temporal integration. MethodsWe studied 39 patients with spinocerebellar degeneration (SCD), comprising spinocerebellar atrophy 6 (SCA6), SCA31, Machado–Joseph disease (MJD, also called SCA3), and multiple system atrophy (MSA). Thirteen normal subjects participated as controls. Participants were instructed to tap on a button in synchrony with isochronous tones. We analyzed the inter-tap interval (ITI), synchronizing tapping error (STE), negative asynchrony, and proportion of delayed tapping as indicators of tapping performance. ResultsThe ITI coefficient of variation was increased only in MSA patients. The standard variation of STE was larger in SCD patients than in normal subjects, especially for MSA. Negative asynchrony, which is a tendency to tap the button before the tones, was prominent in SCA6 and MSA patients, with possible basal ganglia involvement. SCA31 patients exhibited normal to supranormal performance in terms of the variability of STE, which was surprising. ConclusionsCerebellar patients generally showed greater STE variability, except for SCA31. The pace of tapping was affected in patients with possible basal ganglia pathology. SignificanceOur results suggest that interaction between the cerebellum and the basal ganglia is essential for temporal processing. The cerebellum and basal ganglia and their interaction regulate synchronized tapping, resulting in distinct tapping pattern abnormalities among different SCD subtypes.

How do patients with Parkinson's disease and cerebellar ataxia read aloud? -Eye-voice coordination in text reading.

The coordination between gaze and voice is closely linked when reading text aloud, with the gaze leading the reading position by a certain eye-voice lead (EVL). How this coordination is affected is unknown in patients with cerebellar ataxia and parkinsonism, who show oculomotor deficits possibly impacting coordination between different effectors. To elucidate the role of the cerebellum and basal ganglia in eye-voice coordination during reading aloud, by studying patients with Parkinson's disease (PD) and spinocerebellar degeneration (SCD). Participants were sixteen SCD patients, 18 PD patients, and 30 age-matched normal subjects, all native Japanese speakers without cognitive impairment. Subjects read aloud Japanese texts of varying readability displayed on a monitor in front of their eyes, consisting of Chinese characters and hiragana (Japanese phonograms). The gaze and voice reading the text was simultaneously recorded by video-oculography and a microphone. A custom program synchronized and aligned the gaze and audio data in time. Reading speed was significantly reduced in SCD patients (3.53 ± 1.81 letters/s), requiring frequent regressions to compensate for the slow reading speed. In contrast, PD patients read at a comparable speed to normal subjects (4.79 ± 3.13 letters/s vs. 4.71 ± 2.38 letters/s). The gaze scanning speed, excluding regressive saccades, was slower in PD patients (9.64 ± 4.26 letters/s) compared to both normal subjects (12.55 ± 5.42 letters/s) and SCD patients (10.81 ± 4.52 letters/s). PD patients' gaze could not far exceed that of the reading speed, with smaller allowance for the gaze to proceed ahead of the reading position. Spatial EVL was similar across the three groups for all texts (normal: 2.95 ± 1.17 letters/s, PD: 2.95 ± 1.51 letters/s, SCD: 3.21 ± 1.35 letters/s). The ratio of gaze duration to temporal EVL was lowest for SCD patients (normal: 0.73 ± 0.50, PD: 0.70 ± 0.37, SCD: 0.40 ± 0.15). Although coordination between voice and eye movements and normal eye-voice span was observed in both PD and SCD, SCD patients made frequent regressions to manage the slowed vocal output, restricting the ability for advance processing of text ahead of the gaze. In contrast, PD patients experience restricted reading speed primarily due to slowed scanning, limiting their maximum reading speed but effectively utilizing advance processing of upcoming text.

Effects of Intensive Exercise on Cognitive Dysfunction in Patients With Pure Cerebellar Degeneration: A Single-Arm Pilot Study.

To clarify the profile of cognitive dysfunction and the effects of intensive exercise in spinocerebellar degeneration (SCD). We enrolled 60 healthy controls and 16 patients with purely cerebellar type SCD without gait disturbance or organic changes other than cerebellar changes. To assess cognitive function, we evaluated the participants using the Mini-Mental State Examination (MMSE), Frontal Assessment Battery (FAB), and Montreal Cognitive Assessment-Japanese (MoCA-J) at admission and after intensive exercise. Compared to the controls, SCD patients showed significant cognitive decline. As a result of intensive exercise, significant improvements in motor and cognitive functions were observed: the MMSE score improved from 27.7±1.9 to 29.0±1.3 points (p<0.001); the FAB score improved from 14.8±2.2 to 15.8±2.0 points (p=0.002); and the MoCA-J score improved from 24.6±2.2 to 26.7±1.9 points (p<0.001). For sub-scores, significant improvements were noted in serial 7, lexical fluency, motor series, and delayed recall. Our study indicates that intensive exercise can be effective not only for motor dysfunction but also for cognitive dysfunction (Clinical Trial Registration No. UMIN-CTR: UMIN000040079).

Frequency analyses of posturography using logarithmic translation

Background: Power-spectral analysis of the centre of pressure (CoP) frequencies of posturography provides exponentially approximated distributions, whereas logarithmic translation enables linear approximation.Objectives: Frequency analyses were adopted for posturography of healthy subjects and patients with spinocerebellar degeneration (SCD) using logarithmic translation to determine its clinical usefulness for managing the elderly and patients with disequilibrium.Material and methods: We included 172 healthy subjects and 47 SCD patients. Posturography was performed with the eyes fixated and closed, with and without foam rubber. The power-spectral data of the CoP were obtained with the maximum entropy method. Power-spectral data were logarithmically translated for quantitative evaluation.Results: For teenagers, high-frequency fluctuations were dominant and attributable to proprioceptive compensation due to immature postural control. In elderly populations, the increased frequency in the lateral direction was characterised by three peaks indicating postural disturbances attributed to three sensory inputs. The disappearance of one peak in the anteroposterior fluctuation indicates a decrease in vestibular contribution. The foam rubber and the closed-eye condition enhanced fluctuations in two peaks. There were differences in power-spectral distributions of two peaks between the healthy subjects and SCD patients.Conclusions: Logarithmic power-spectral data distribution could provide an age- and disease-specific novel and visually-comprehensible parameter.

The evaluation of gravitational recognition in patients with spinocerebellar degeneration using Listing’s plane

Background: The thickness of Listing’s plane accurately reflects gravitational recognition, constructed through the integration of visual, vestibular, and proprioceptive sensory input in the neural integrator of the central nervous system. Spinocerebellar degeneration (SCD) is a progressive degenerative disease mainly involving the cerebellum and brainstem that leads to destabilize the gravitational recognition, and may thicken thickening of Listing’s plane.Objective: The aim of this study is to evaluate the gravitational recognition in response to positional change in patients with SCD, using the thickness of Listing’s plane as a parameter.Materials and methods: In this prospective study, we evaluated the thickness of Listing’s plane in 21 consecutive patients with SCD and 32 healthy subjects in the seated and supine positions, and investigated the association with other neuro-otological examinations (electronystagmography including caloric test and posturography).Results: We detected significant thickening of Listing’s plane in SCD patients only when they were in the seated position. The thickness of Listing’s plane correlated with neither the caloric response nor Romberg’s ratio or the total center of the pressure path length.Conclusions and significance: The thickness of Listing’s plane could be a useful parameter for assessing a gravity-oriented internal model in SCD patients.

The Responsiveness of Triaxial Accelerometer Measurement of Gait Ataxia Is Higher than That of the Scale for the Assessment and Rating of Ataxia in the Early Stages of Spinocerebellar Degeneration.

We reported previously that the average medial-lateral gait amplitude while walking on a straight path determined using triaxial accelerometers fixed on the middle of the upper back may be a quantitative and concise indicator for the severity of cerebellar ataxia. Considering that gait ataxia is a typical initial symptom in a variety of spinocerebellar degeneration (SCD), we aimed to develop quantitative biomarkers for cerebellar ataxia as metric variables. We used triaxial accelerometers to analyze gait parameters in 14 patients with SCD at 3 points over 3years (at baseline, 1.5years and 3years). Analysis of covariance (ANCOVA) models adjusted for the baseline scores were used to estimate sample sizes. The mean medial-lateral amplitude (ML) gained by a triaxial accelerometer fixed on upper back could detect the each 1.5-year change. In the 14 patients, the mean ML(m) was 0.032 ± 0.007(SD) at entry, 0.037 ± 0.008 after 1.5-year follow, and 0.042 ± 0.020 after 3-year follow. In contrast, SARA gait scores were 2.9, 2.9, and 3.0, respectively. The responsiveness of the quantitative evaluation of gait ataxia by triaxial accelerometers is higher than that of the SARA within a 1.5-year follow-up period. Gait analysis by triaxial accelerometers will be complementary to the evaluation of scales like SARA in the assessment of clinical severity of SCD patients in early stage.

The educational programs for extrapyramidal disease and spinocerebellar degeneration patients and their families

AbstractBackgroundExtrapyramidal disease and spinocerebellar degeneration patients and their families have less information about their diseases, which deteriorate the quality of life of these patients and increase the burdens on their families.AimWe designed our study for the purpose of improving the quality of life of these patients and decreasing the burdens on their families by giving enough information to them.MethodsWe conducted educational programs for these patients and their families, consisting of lectures on the symptoms and courses of the diseases, rehabilitation, social support, dysarthria, and dysphagia. To evaluate the efficacy of our programs, we administered the 36‐Item Short‐Form Health Survey to the patients and the Zarit Burden Interview to their families both before and after these programs.ResultsThirty‐three patients joined our programs with their families. Of these, 22 had Parkinson's disease, four had progressive supranuclear palsy, four had multiple system atrophy, two had spinocerebellar degeneration, and one had undiagnosed parkinsonism. The Physical Component Summary, the Mental Component Summary, the Role‐social Component Summary scores of the 36‐Item Short‐Form Health Survey, and the scores of the Zarit Burden Interview before and after the programs were 33.4 and 87.7, 55.5 and 48.5, 30.6 and 30.8, and, 19.7 and 19.1, respectively. There was no significant difference in Zarit Burden Interview and the 36‐Item Short‐Form Health Survey other than the subscales of physical functioning and vitality.ConclusionsOur programs could not improve the quality of life of the patients and could not also reduce the burdens on their families.

P1-2-09. Saccadic eye movements in spinocerebellar degeneration – correspondence to clinical manifestation

Objectives The cerebellum is implicated in the control of saccade but saccade abnormality in cerebellar disorders is not fully delineated, especially in the vertical directions. To clarify the role of the cerebellum, we studied saccades in hereditary spinocerebellar degeneration (SCD) with pure cerebellar presentation. Methods Subjects were 20 SCD patients (SCA6, 31) and 19 normal age-matched controls. We used the visual guided (VGS) and memory guided saccade tasks (MGS) in which targets were presented in 8 possible directions with 45 degree separation, and recorded saccades with a video-based eye tracker. Results In SCA patients, latency was significantly delayed mainly in vertical and oblique directions, which correlated with SARA scores. The number of both overshoot and undershoot increased correlatively with SARA scores in all directions. Peak velocity showed no change, but the time from the beginning to the peak velocity of the saccade was shorter, whereas the time from the peak velocity to the end of saccade was longer. Conclusion The change in amplitude and velocity profile may reflect abnormal output from the cerebellar nuclei, whereas the pathophysiology of prolonged latency remains elusive. We hope the saccade analysis paves the way toward objective assessment of SCD and other neurological disorders.

Wearable gait sensors to measure ataxia due to spinocerebellar degeneration

AbstractBackground and AimLimited attention has been paid to the relationship between wearable gait sensors in cerebellar ataxia.ObjectiveWe aimed to correlate a bed‐side ataxia measure with wearable gait sensor parameters in patients with spinocerebellar degeneration (SCD).MethodsWe recruited 14 SCD patients capable of walking independently: six men and eight women, mean age 59.4 years, disease duration 5.3 years, pure cerebellar type 10, cerebellar‐plus type 4, but with few symptoms other than cerebellar ataxia. All patients were assessed by the Scale for the Assessment and Rating of Ataxia (SARA) and the Gait‐Kun system, a wearable gait sensor with triple‐axial accelerometers. Statistical analysis was performed by Spearman's rank correlation coefficient test and multiple regression analysis test. Significance was estimated as P &lt; 0.05.ResultsWe found that (i) the Gait‐Kun system can be used easily in cerebellar ataxia patients; (ii) Spearman's rank correlation coefficient test showed a close relationship between SARA gait subcategory and (a) converted number of steps (indicating shorter stride) (P &lt; 0.01) and (b) step‐width variation (indicating staggering) (P &lt; 0.01); and (iii) multiple regression analysis showed a close relationship between SARA gait and converted number of steps (indicating shorter stride) (P = 0.001).ConclusionUsing the Gait‐Kun system (wearable sensors), there was a close relationship between SARA gait subcategory and both converted number of steps and step‐width variation, indicating that not only step‐width variability but also shorter stride is a feature of ataxic gait abnormalities.

Quantitative evaluation of gait ataxia by accelerometers

An appropriate biomarker for spinocerebellar degeneration (SCD) has not been identified. Here, we performed gait analysis on patients with pure cerebellar type SCD and assessed whether the obtained data could be used as a neurophysiological biomarker for cerebellar ataxia. We analyzed 25 SCD patients, 25 patients with Parkinson's disease as a disease control, and 25 healthy control individuals. Acceleration signals during 6min of walking and 1min of standing were measured by two sets of triaxial accelerometers that were secured with a fixation vest to the middle of the lower and upper back of each subject. We extracted two gait parameters, the average and the coefficient of variation of motion trajectory amplitude, from each acceleration component. Then, each component was analyzed by correlation with the Scale for the Assessment and Rating of Ataxia (SARA) and the Berg Balance Scale (BBS). Compared with the gait control of healthy subjects and concerning correlation with severity and disease specificity, our results suggest that the average amplitude of medial-lateral (upper back) of straight gait is a physiological biomarker for cerebellar ataxia. Our results suggest that gait analysis is a quantitative and concise evaluation scale for the severity of cerebellar ataxia.

Is multiple system atrophy with cerebellar ataxia (MSA-C) like spinocerebellar ataxia and multiple system atrophy with parkinsonism (MSA-P) like Parkinson’s disease? – A saccade study on pathophysiology

ObjectivePatients with multiple system atrophy (MSA) are classified into those mainly manifesting cerebellar ataxia (MSA-C) and those mainly manifesting parkinsonism (MSA-P). Pathophysiological bases of these subtypes remain unclear. We hypothesized that MSA-C patients would resemble spinocerebellar degeneration patients and MSA-P patients would resemble Parkinson’s disease (PD) patients in saccade abnormalities. MethodsWe recorded visually guided and memory guided saccades (MGS) in 27 MSA-C and 15 MSA-P patients, as well as 50 age-matched normal subjects, 14 spinocerebellar degeneration patients showing pure cerebellar symptoms (SCD) and 61 Parkinson’s disease (PD) patients. ResultsSaccade parameters of both tasks showed similar changes with progressing disease in SCD and MSA-C patients, as did those of MSA-C and MSA-P patients, although hypometria was slightly more pronounced in MSA-P. In both subtypes of MSA, latency and success rate of MGS were stable throughout disease stages, whereas they deteriorated progressively with progressing disease in PD. ConclusionsPathophysiology underlying MSA-C and MSA-P is similar as viewed from saccade performance. The MGS performance in MSA was preserved. However, MSA-P patients showed more marked hypometria, suggesting a mixture of basal ganglia pathophysiology. SignificanceThe similarity of saccade performance between MSA-C and MSA-P may reflect common olivopontocerebellar pathology, while the direct pathway of the basal ganglia is relatively spared compared with PD, even in MSA-P.

1-P-E-6. Saccade abnormalities in multiple system atrophy – Comparison between MSA-C and MSA-P

Multiple system atrophy (MSA) is classified into subtypes mainly showing cerebellar ataxia (MSA-C) and parkinsonism (MSA-P). To characterize the pathophysiological difference between the two subtypes, we recorded performances of visually guided (VGS) and memory guided saccade (MGS) tasks in 27 MSA-C patients, 14 MSA-P patients, 14 patients with spinocerebellar degeneration (SCD) exhibiting pure cerebellar symptoms, 61 Parkinson’s disease (PD) patients, and 50 age-matched normal subjects. Compared to normal subjects, VGS latency was prolonged and VGS accuracy reduced in all patient groups, and the changes progressively deteriorated with advancing disease. In contrast, the latency and success rate of MGS stayed similar to the normal level throughout the disease stages for SCD, MSA-C, and MSA-P patients, whereas in PD patients, both latency and success rate of MGS deteriorated progressively with advancing disease. MGS amplitude was reduced compared to normal subjects and deteriorated progressively with advancing disease stage in MSA-P and PD patients, but not in SCD patients. The results suggest that in terms of saccade latency MSA shows changes more similar to SCD, indicating that function of the direct pathway of the basal ganglia is relatively preserved compared with PD. Meanwhile, MGS amplitude in MSA-P shows a decline similar to PD patients.

6.脊髄小脳変性症

Spinocerebellar degeneration (SCD) is an inherited neurological disorder characterized by the slow degeneration of the brainstem and cerebellum. The Motor Ataxia Research Group has reported that there are more than 36,000 patients in Japan. Previously, SCD was classified by the clinical symptoms so that it was hard to make a distinct diagnosis. After the 1990s, SCD was identified genetically and has been classified into more than 60 different types. This classification has facilitated our approach to the restricted neuronal function of the brain stem and cerebellum. Usually the diagnosis comes after examination by a neurologist, which includes a physical exam, family history, MRI scanning of the brain and spine, and spinal tap. However, the patients frequently reveal unsteadiness of gait associated with nystagmus that could be also observed in the patients with peripheral vestibular impairment. For this, one third of the SCD patients visit otolaryngologists at their first hospital visit. For an accurate diagnosis, an eye movement examination is necessary. Brainstem and cerebellar lesions affect physiological eye movements, e.g., saccade, smooth pursuit and VOR suppression. Eye gains during those physiological eye movements in SCD patients are significantly lower than controls. Although it is not necessary for them to be an expert, otolaryngologists should understand the role of the brain stem and cerebellum, especially how they affect movements of the eye.

Characteristics of depression in Parkinson's disease: Evaluating with Zung's Self-Rating Depression Scale

The purpose of the study was to elucidate characteristics of depression in Parkinson's disease (PD). Fifty-eight PD patients were evaluated with Zung's Self-Rating Depression Scale (SDS) and the Unified Parkinson's Disease Rating Scale (UPDRS). Scores for “suicidal ideation” on the SDS correlated with posture and gait disturbances on the UPDRS. Twenty-six patients with spinocerebellar degeneration (SCD) were also evaluated with the SDS. SDS scores for “indecisiveness” and “constipation” were significantly higher in PD patients than SCD patients. Our results suggest that depression is common in disabled persons but PD patients might have a characteristic clinical presentation.

Clinical and genetic epidemiological study of 16q22.1-linked autosomal dominant cerebellar ataxia in western Japan

Autosomal dominant cerebellar ataxia (ADCA) is a heterogeneous neurodegenerative disorder. A single nucleotide substitution in the puratrophin-1 gene is associated with 16q22.1-linked ADCA showing pure cerebellar ataxia. We screened patients with spinocerebellar degeneration (SCD) to investigate the frequency and clinical features of 16q22.1-linked ADCA. We examined 91 SCD patients from a 1998 community-based prevalence study of Tottori Prefecture in western Japan. We also analyzed samples from 176 patients with SCD collected from a 1996 to 2006 laboratory-based study. In the community-based study, the prevalence of spinocerebellar ataxia 6 (SCA6) and 16q22.1-linked ADCA was 2.4 and 1.12 per 100,000 individuals, respectively. In the laboratory-based study, the frequency of SCA6 and 16q22.1-linked ADCA was 28% and 17%, respectively. We found two cases of 16q22.1-linked ADCA among 26 SCD patients with no family history. In this area in Japan, 16q22.1-linked ADCA was the second most common type of hereditary SCD.

Longitudinal Study of Bone and Calcium Metabolism and Fracture Incidence in Spinocerebellar Degeneration

Little is known about bone and calcium metabolism and fracture incidence in spinocerebellar degeneration (SCD) despite frequent falls and immobilization. To address bone and calcium metabolism and fracture incidence in SCD, we conducted a 10-year prospective study in a cohort of adult patients with SCD. Bone mineral density (BMD) and serum levels of ionized calcium, parathyroid hormone, 25-hydroxyvitamin D, and pyridinoline cross-linked carboxy-terminal telopeptide of type I collagen (ICTP) were followed in 110 patients with SCD for 10 years. Age-matched healthy volunteers (n = 110) served as controls. At baseline, the SCD patients had a low BMD with high levels of serum ionized calcium and ICTP which correlated with the degree of immobilization (Barthel index). Over 10 years, serum 25-hydroxyvitamin D decreased to the osteomalacic level (<5 ng/ml), and calcium and ICTP further increased in accordance with a decreased Barthel index score. The BMD decreased by 15.2% in men and by 24.6% in women. The incidence of fractures in the patients was significantly higher as compared with the control group (men 8/49 vs. 1/42, p = 0.0428; women 16/49 vs. 2/48, p = 0.0026). Over 10 years, the BMD was significantly reduced in the SCD patients, particularly in women, which increased the risk of a fracture. Vitamin D deficiency due to sunlight deprivation, increased bone resorption due to immobilization, and frequent falls are probable causes of osteoporosis and fractures in these patients. Hypovitaminosis D and increased bone resorption may be corrected readily by the routine use of vitamin D supplements together with bisphosphonate.

脊髄小脳変性症の遺伝子型と眼球運動障害についての検討

Spinocerebellar degeneration (SCD) exhibits a variety of spinal and cerebullar symptoms and progress. The recent advent of molecular genetics has revealed triplet repeat mutation in the gene of SCD patients. Due to the underlying genetic defects, hereditary SCD is referred to as different spinocerebellar ataxia (SCA) genotypes. We conducted vestibular functional tests in 33 SCD patients, including 3 with SCA3 and 2 with SCA6. We compared the degree of lower extremity ataxia with the degree of oculomotor disorder by using eye tracking tests (ETT) and optokinetic pattern tests (OKP). Both SCA3 and SCA6 show high ETT score and low mean slowest phase velocity in OKP. This means that SCA3 and SCA6 tend to have oculomotor disorder precedes extremity ataxia. Oculomotor examination should thus prove to be a useful, senstive indicator in screening SCD patients from early disease onset, and in evaluating the disease progression and the effectiveness of treatment.

Remote effect of repetitive transcranial magnetic stimulation on the cerebellum of spinocerebellar degeneration patients

In order to investigate the effect of repetitive transcranial magnetic stimulation (rTMS) on the cerebellum of spinocerebellar degeneration (SCD) patients, the hemodynamic changes of the brain during rTMS was measured using noninvasive dynamic multi-channel near-infrared optical topography (OT). Two SCD patients diagnosed as OPCA participated in this study. Both had been having rTMS administered to their cerebellum once a week for more than 2 years for therapeutic purposes under the permission of the local ethical committee. Three sessions of 15 times application of 1 Hz rTMS were applied at 3-min intervals. OT probes were set on the scalp and the hemodynamic changes of the fronto-paretal lobe were measured during each session. Changes in hemoglobin were recorded at 15-s prestimulus intervals and consecutively 195 s during and after stimulus. Increased blood flow around the premotor area was observed during rTMS, and the effects were prolonged for more than at least a couple of minutes after rTMS. These results suggest that rTMS administered to the cerebellum of SCD patients may have a remote effect on the frontal lobe and that the blood flow of the frontal lobe may change during and after rTMS.

Spinocerebellar degeneration with negative electroretinogram: dysfunction of the bipolar cells

We report the characteristics of three patients with spinocerebellar degeneration (SCD) with negative-type electroretinograms (ERGs). None of the patients showed retinal degeneration, but all had severe cerebellar ataxia, and brain MRIs showed cerebellar atrophy. Negative-type ERGs have been implicated in the selective functional impairment of the inner retinal layer, but few studies have reported dysfunction of the inner nuclear layer in SCD patients. Our subjects may be the first reported SCD cases with negative-type ERGs. Our results suggest that an etiologic relationship exists between cerebellar ataxia and negative-type ERGs. Further investigation of ERGs in patients with SCD could potentially lead to the identification of an increased number of SCD patients with negative-type ERGs and retinal pathogenesis.

The association between lipidemic, inflammation and coagulation factors with depressive symptoms, in cardiovascular disease-free people

The purpose of the study was to elucidate characteristics of depression in Parkinson's disease (PD). Fifty-eight PD patients were evaluated with Zung's Self-Rating Depression Scale (SDS) and the Unified Parkinson's Disease Rating Scale (UPDRS). Scores for “suicidal ideation” on the SDS correlated with posture and gait disturbances on the UPDRS. Twenty-six patients with spinocerebellar degeneration (SCD) were also evaluated with the SDS. SDS scores for “indecisiveness” and “constipation” were significantly higher in PD patients than SCD patients. Our results suggest that depression is common in disabled persons but PD patients might have a characteristic clinical presentation.