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Original Articles
- Associations Between the Vestibulo-Ocular Reflex and Cognitive Function in de novo Parkinson’s Disease
- Mincheol Park, Hyun Joo Kim, Chan-Nyoung Lee, Kun-Woo Park, Sun-Uk Lee, Kyoungwon Baik
- Received August 28, 2025 Accepted February 20, 2026 Published online February 23, 2026
- DOI: https://doi.org/10.14802/jmd.25230 [Epub ahead of print]
- 657 View
- 69 Download
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Abstract
PDF - Objective
Vestibulo-ocular reflex (VOR) impairment has been reported in Parkinson’s disease (PD). However, its clinical implications, particularly with respect to cognition, remain unclear. We investigated canal-specific VOR changes and their associations with cognitive function, motor symptoms, gaits, and dopamine transporter (DAT) uptake in de novo PD patients.
Methods
We prospectively enrolled 127 patients with de novo PD who underwent video head-impulse tests (video-HITs), comprehensive neuropsychological assessments, gait analysis, and 18F-N-(3-fluoropropyl)-2β-carbon ethoxy-3β-(4-iodophenyl) nortropane positron emission tomography. Associations between VOR gains and the clinical characteristics of PD were evaluated using general linear models adjusted for age, sex, and education level. Cognitive analyses were performed after the patients were stratified into PD with normal cognition (PD-NC) and PD with mild cognitive impairment (PD-MCI) groups. Partial correlation analyses were performed to assess the relationships between VOR gains and regional DAT uptake.
Results
Decreased VOR gain in at least one canal was observed in 22 patients (17.32%). Horizontal canal (HC) gain was positively associated with the Korean version of Montreal Cognitive Assessment score (p=0.040), and anterior canal (AC) gain was negatively associated with the base of support (p=0.018). The patterns of association between VOR gains and neuropsychological measures differed between the PD-NC and PD-MCI groups. In addition, VOR–cognition relationships were canal-specific: HC gain was positively related to visuospatial function, whereas AC and posterior canal gains were negatively related to language and frontal–executive functions. DAT uptake in the locus coeruleus was positively correlated with HC gain (p=0.020).
Conclusion
VOR integrity is associated with cognitive and gait function in patients with PD. Video-HITs may serve as potential biomarkers for disease monitoring in PD patients.
- Subtyping of Parkinson’s Disease by Longitudinal Trajectories of Levodopa Equivalent Daily Dose
- Young-gun Lee, Kyoungwon Baik, Mincheol Park, Sung Woo Kang, So Hoon Yoon
- J Mov Disord. 2025;18(4):317-326. Published online July 18, 2025
- DOI: https://doi.org/10.14802/jmd.25099
- 4,146 View
- 137 Download
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Abstract
PDF
Supplementary Material - Objective
Clinical heterogeneity exists in the optimal timing and dosage of symptomatic treatments for Parkinson’s disease (PD). This study aimed to cluster PD patients on the basis of longitudinal trajectories of levodopa equivalent daily dose (LEDD) and evaluate the clinical features and progression associated with these clusters.
Methods
From the Parkinson’s Progression Markers Initiative database, we enrolled 301 PD patients who were followed up for at least 3 years after the initiation of antiparkinsonian medications. On the basis of the longitudinal trajectories of the LEDD increment, the participants were classified into three clusters: slow-increment, initial-increment, and rapid-increment. The outcomes were initial and longitudinal changes in motor phenotype, on-time motor symptoms, and the efficacy of antiparkinsonian medications.
Results
The initial-increment cluster exhibited the greatest symptomatic improvements following the administration of higher doses of LEDD, although the motor improvement per unit of LEDD was comparable across clusters. Longitudinally, motor phenotypes changed rapidly in the initial-increment cluster. The initial-increment cluster showed continuous worsening of on-time motor symptoms, with limited LEDD efficacy. In contrast, the rapid-increment cluster exhibited stable on-time motor symptoms, whereas the efficacy of antiparkinsonian medications declined over time. The risk of disability related to walking and balance milestones and motor complications was twice as high in the initial-increment and rapid-increment clusters than in the slow-increment cluster.
Conclusion
Heterogeneity is noted in the increase in the use of antiparkinsonian medications, which is driven by changes in motor phenotype, medication efficacy, and the occurrence of PD-relevant milestones. Subtyping patients on the basis of LEDD trajectories may provide insight into clinical heterogeneity for future research on individualized treatment strategies for patients with PD.
- Ocular Vestibular-Evoked Myogenic Potential Assists in the Differentiation of Multiple System Atrophy From Parkinson’s Disease
- Keun-Tae Kim, Kyoungwon Baik, Sun-Uk Lee, Euyhyun Park, Chan-Nyoung Lee, Tonghoon Woo, Yukang Kim, Seoui Kwag, Hyunsoh Park, Ji-Soo Kim
- J Mov Disord. 2024;17(4):398-407. Published online July 9, 2024
- DOI: https://doi.org/10.14802/jmd.24120
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Abstract
PDFSupplementary Material
- Objective
Vestibular-evoked myogenic potentials (VEMPs) can help in assessing otolithic neural pathway in the brainstem, which may also contribute to the cardiovascular autonomic function. Parkinson’s disease (PD) is associated with altered VEMP responses; however, the associations between VEMP abnormalities and multiple system atrophy (MSA) remain unknown. Therefore, we compared the extent of otolith dysfunction using ocular (oVEMP) and cervical VEMPs between patients with MSA and PD.
Methods
We analyzed the clinical features, VEMP, and head-up tilt table test (HUT) findings using the Finometer in 24 patients with MSA and 52 with de novo PD who had undergone neurotologic evaluation at a referral-based university hospital in South Korea from January 2021 to March 2023.
Results
MSA was associated with bilateral oVEMP abnormalities (odds ratio [95% confidence interval] = 9.19 [1.77–47.76], p = 0.008). The n1–p1 amplitude was negatively correlated with the Unified Multiple System Atrophy Rating Scale I-II score in patients with MSA (r = -0.571, p = 0.033), whereas it did not correlate with the Movement Disorder Society-Unified Parkinson’s Disease Rating Scale-III score in patients with PD (r = -0.051, p = 0.687). The n1 latency was negatively correlated with maximum changes in systolic blood pressure within 15 s during HUT in patients with PD (r = -0.335, p = 0.040) but not in those with MSA (r = 0.277, p = 0.299).
Conclusion
Bilaterally abnormal oVEMP responses may indicate the extent of brainstem dysfunction in MSA. oVEMP reflects the integrity of otolith-autonomic interplay, reliably assists in differentiating between MSA and PD, and helps infer clinical decline. -
Citations
Citations to this article as recorded by
- Balance biomarker for early differentiation of Parkinson’s disease and multiple system atrophy with parkinsonian type
Hee Jin Chang, Jong Ho Kim, Han-Wook Song, Sanghyun Lee, Eunjin Kwon, Seong-Hae Jeong, Eungseok Oh
Journal of Neurology.2026;[Epub] CrossRef - Saccadic variability in patients with Parkinson’s disease
Kyoungwon Baik, Seoyeon Byun, Seoui Kwag, Sarah Hyunsoh Park, Yukang Kim, Tonghoon Woo, Sun-Uk Lee, Chan-Nyoung Lee, Gerard J. Kim, Byung-Jo Kim, Ji-Soo Kim, Kun-Woo Park
Journal of Neurology.2026;[Epub] CrossRef - Vestibular Evoked Myogenic Potentials (VEMPs) in Parkinson’s Disease Patients with Monopolar Deep Brain Stimulation
Kim E. Hawkins, John Holden, Elodie Chiarovano, Simon J. G. Lewis, Ian S. Curthoys, Hamish G. MacDougall
Signals.2025; 6(1): 10. CrossRef - Update on Clinical Physiology and Pathomechanisms for Vestibulo-Autonomic Interplay
Sun-Uk Lee, Jeong-Yoon Choi
The Cerebellum.2025;[Epub] CrossRef - Selective otolithic dysfunction in patients presenting with acute spontaneous vertigo: consideration based on MRI
Keun-Tae Kim, Sangeun Park, Sun-Uk Lee, Euyhyun Park, Byungjun Kim, Ji-Soo Kim
Frontiers in Neurology.2024;[Epub] CrossRef
- Balance biomarker for early differentiation of Parkinson’s disease and multiple system atrophy with parkinsonian type
Letter to the editor
- Factors associated with anticholinergic-induced oral-buccal-lingual dyskinesia in Parkinson’s disease
- Joonyoung Ha, Suk Yun Kang, Kyoungwon Baik, Young H. Sohn, Phil Hyu Lee, Min Seok Baek, Jin Yong Hong
- J Mov Disord. 2024;17(1):109-111. Published online September 22, 2023
- DOI: https://doi.org/10.14802/jmd.23069
- 3,431 View
- 98 Download
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