Current Perspectives on the Assessment and Management of Gait Disorders in Parkinson’s Disease

Abstract

Gait dysfunction is a key defining feature of Parkinson’s disease (PD), and is associated with symptoms of freezing and an increased risk of falls. In this narrative review, we cover the putative mechanisms of gait dysfunction in PD, the assessment of gait abnormalities, and the management of symptoms caused by the inherent difficulty in walking. Our understanding of the causes of gait problems in PD has progressed in recent times, moving from neurocognitive theory to correlates of affected neuronal pathways. In particular, this can be shown to correspond with abnormalities in responses to dual-task paradigms and dysfunction in cholinergic signaling. Great progress has been made in the sophistication and precision of gait assessment; however, it has firmly remained in the research domain. There is significant momentum behind wearable technologies that can be used by patients in their own environment, acting as digital biomarkers that can not only reflect progression but also independently discriminate PD from non-PD individuals. The treatment of gait dysfunction has historically relied on physical therapies and training combined with a view to mitigating the impact of such consequences as falls. Pharmacological therapies that are the mainstay of treatment in PD have tended to address symptoms like bradykinesia; however, optimization of dopaminergic therapies likely has a positive effect on quality of gait. Other targets have been assessed with the goal of improving gait, of which medications that improve cholinergic signaling appear most promising. Neuromodulation techniques are increasingly used in the form of deep-brain stimulation; however, standard targets, such as the globus pallidus interna, have a modest effect on gait. Considerable benefit has been seen through targeting the pedunculopontine nucleus, and a dual-target approach may be warranted. Stimulation of the spinal cord and brain through direct or magnetic approaches has been assessed, but requires further evidence.

The implications of the foot health status in Parkinson patients: A case–control study

“…In addition, the aforementioned rheumatological deformity of the fingers and hands favours said difficulty in using devices for cutting nails, as well as the tremor present in the extremities. 9,[26][27][28][29] Regarding the results obtained in our study in the pain dimension, the patients with Parkinson's reported having discomfort and moderate pain to a greater extent than the healthy participants, although this result did not show statistically significant differences between the two groups. Previous studies highlight the issue of suffering from pain in Parkinson's patients.…”

“…In addition, the aforementioned rheumatological deformity of the fingers and hands favours said difficulty in using devices for cutting nails, as well as the tremor present in the extremities. 9 , 26 , 27 , 28 , 29 …”

High risk of developing dementia in Parkinson’s disease: a Swedish registry-based study

“…When we changed the definition of dementia to having been prescribed an anti-dementia drug (ATC class N06D), we observed an increase in the number of dementia cases, as well as higher HRs. One possible explanation for the increased number of presumed dementia cases is that anti-dementia drugs (cholinesterase inhibitors) such as rivastigmine have been trialled with trending positive effects on gait stability and fall frequency in PwP, and may therefore have been prescribed off-label for those purposes 31 . Another indication for starting treatment with rivastigmine among PwP might be hallucinations, as reviewed by Samudra et al 32 .…”

Evaluating Gait Impairment in Parkinson’s Disease from Instrumented Insole and IMU Sensor Data

“…Gait is a basic characteristic of human life deeply tied to the quality of life [1]. While it is usually taken for granted, gait as an activity is complex and rich in information.…”

“…At the same time, it is also the most daunting. Gait disturbances exhibited in Parkinson's disease are multifaceted, with their manifestations being hard to identify, as they change and increase in complexity, depending on the disease's stage [1,3].…”