{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,15]],"date-time":"2026-07-15T07:05:45Z","timestamp":1784099145013,"version":"3.55.0"},"reference-count":43,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,7,15]],"date-time":"2026-07-15T00:00:00Z","timestamp":1784073600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Aging Neurosci."],"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Pisa syndrome (PS) is well recognized in Parkinson\u2019s disease (PD) but has been less studied in dementia with Lewy bodies (DLB), and direct comparisons are scarce. The aim of this study is to compare the clinical expression of PS across PD and DLB.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      In this multicenter cross-sectional study, patients were classified as PD without PS (\n                      <jats:italic>n<\/jats:italic>\n                      \u202f=\u202f50), PD with PS (\n                      <jats:italic>n<\/jats:italic>\n                      \u202f=\u202f41), DLB without PS (\n                      <jats:italic>n<\/jats:italic>\n                      \u202f=\u202f45), or DLB with PS (\n                      <jats:italic>n<\/jats:italic>\n                      \u202f=\u202f35). Standardized assessments covered cognition, neuropsychiatric symptoms, caregiver burden, motor severity, gait, falls, daily function. Two-way models, disease-specific logistic regression, and mediation analyses were performed.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>In both disorders, PS was associated with longer disease duration, worse daily functioning, and more recurrent falls. Significant disease \u00d7 PS interactions were observed across cognitive, neuropsychiatric, gait, and fall outcomes. DLB-PS carried the heaviest cognitive and neuropsychiatric burden, whereas PD-PS showed the greatest motor and gait impairment. In PD, PS was independently associated with disease duration, MDS-UPDRS-III score, gait symmetry, and stride length. In DLB, PS was independently associated with lower attention and visuospatial\/executive scores, greater hallucination severity, and a higher CDR stage. Attention\/visuospatial dysfunction partly mediated the association between PS and recurrent falls in DLB, whereas gait asymmetry\/stride impairment partly mediated the same association in PD.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>PS is not a uniform phenotype across Lewy body disorders. Our findings suggest that it behaves relatively more like a cognition-neuropsychiatry-associated axial syndrome in DLB, whereas in PD, it shows stronger associations with motor and gait features. The effect sizes are modest, indicating that PS is a multifactorial clinical sign rather than a strong predictor of any single domain.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fnagi.2026.1856771","type":"journal-article","created":{"date-parts":[[2026,7,15]],"date-time":"2026-07-15T06:11:06Z","timestamp":1784095866000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Clinical heterogeneity of Pisa syndrome across Lewy body disorders: a multicenter comparison of Parkinson\u2019s disease and dementia with Lewy bodies"],"prefix":"10.3389","volume":"18","author":[{"given":"Zhou","family":"Su","sequence":"first","affiliation":[{"name":"Department of Neurology, The First Affiliated Hospital of Henan Medical University","place":["Xinxiang, Henan, China"]},{"name":"Henan Medical Key Laboratory of Neurology, Henan Joint International Laboratory of Neurorestoratology for Senile Dementia, Henan Key Laboratory of Neurorestoratology and Protein Modification","place":["Xinxiang, Henan, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mengran","family":"Liu","sequence":"additional","affiliation":[{"name":"School of Education, University of Bristol","place":["Bristol, United Kingdom"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jun","family":"Kuai","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology, The First Affiliated Hospital of Henan Medical University","place":["Xinxiang, Henan, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xinran","family":"Bao","sequence":"additional","affiliation":[{"name":"Department of Neurology, First Hospital of Qinhuangdao","place":["Hebei, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xia","family":"Guo","sequence":"additional","affiliation":[{"name":"Department of Neurology, The First Affiliated Hospital of Baotou Medical College","place":["Baotou, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Meimei","family":"Zuo","sequence":"additional","affiliation":[{"name":"Department of Neurology, Cangzhou People\u2019s Hospital","place":["Cangzhou, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hao","family":"Wu","sequence":"additional","affiliation":[{"name":"Tianjin Key Laboratory of Cerebrovascular and of Neurodegenerative Diseases, Department of Neurology, Tianjin Huanhu Hospital, Tianjin Dementia Institute","place":["Tianjin, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jinghuan","family":"Gan","sequence":"additional","affiliation":[{"name":"Department of Neurology, Beijing Friendship Hospital, Capital Medical University","place":["Beijing, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shuai","family":"Liu","sequence":"additional","affiliation":[{"name":"Tianjin Key Laboratory of Cerebrovascular and of Neurodegenerative Diseases, Department of Neurology, Tianjin Huanhu Hospital, Tianjin Dementia Institute","place":["Tianjin, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yong","family":"Ji","sequence":"additional","affiliation":[{"name":"Tianjin Key Laboratory of Cerebrovascular and of Neurodegenerative Diseases, Department of Neurology, Tianjin Huanhu Hospital, Tianjin Dementia Institute","place":["Tianjin, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,7,15]]},"reference":[{"key":"ref1","doi-asserted-by":"publisher","DOI":"10.1186\/s13195-024-01539-z","article-title":"Dementia with Lewy bodies and gait neural basis: a cross-sectional study","volume":"16","author":"Adele","year":"2024","journal-title":"Alzheimer's Res. 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