Determinants of gait in the elderly parkinsonian on maintenance levodopa/carbidopa therapy.

Abstract

London WC1 lAX 1 We have used gait analysis to investigate the efficacy of maintenance therapy with a levodopa/carbidopa combination in patients with idiopathic Parkinsonism, who do not have overt fluctuations in control in relation to administration of medication. 2 Fourteen patients (aged 64 to 88 years) receiving maintenance therapy with levodopa and carbidopa (Sinemet Plus) entered a placebo-controlled, randomised cross-over study of the effect of omission of a morning dose of active treatment on distance/time parameters of gait. Measurements made 2, 4 and 6 h after the morning treatment were standardised by taking the pre-treatment measurement on that day as baseline. 3 The mean increase in stride length (7%) and decrease in double support time (20%) on active treatment were small but statistically significant (P < 0.0001, in each case), there being no significant placebo effect on either gait parameter (P = 0.69 and 0.08 respectively). Neither active nor placebo treatments had any significant (P > 0.45 in each case) effect on the lying, standing or postural fall in mean arterial pressure, measurements being made in the same temporal relation to the treatments as was gait. 4 In a generalised linear model, after allowing for the effect (P < 0.0001) of intrinsic variability in pre-treatment speed as well as for structure of the study, nature of treatment had an effect on stride length over the whole walk, significant at P = 0.002. 5 Pre-treatment postural fall in mean arterial pressure was nearly as significant (P = 0.003) as the nature of treatment in the context of such a model: the greater the fall, the greater the increment in stride length seen following active or placebo treatment. This was probably explained by an acquired tolerance to the fall as the day progressed. 6 The major determinant (P < 0.0001) of the change in double support time over the whole walk, after allowing for the structure of the study, appeared to be the post treatment mean arterial standing blood pressure. The lower the pressure, the shorter the double support time, and hence, the greater the tendency to a hurried gait. 7 Nature of treatment, when added into the models described in summary points 5 and 6, had no significant effect (P > 0.25, in each case). 8 In elderly patients without overt fluctuations in performance in relation to medication, the effect of intrinsic variability in mean arterial pressure on gait, may confound the interpretation of an apparent treatment effect on stride length and, to an even greater extent, on double support time.

Gait quantitation in Parkinson's disease ? locomotor disability and correlation to clinical rating scales

“…On the other hand, the values of gait velocity and stride length are even higher in our patients than in some other studies (Stern et al, 1983;Bowes et al, 1990;Blin et al, 1990aBlin et al, ,b, 1991Marini et al, 1992;Morris et al, 1994a,b;Miller et al, 1996). The amount of velocity reduction compared to normals is in the range reported by others (Stern et al, 1983;Bowes et al, 1990;Blin et al, 1991;Morris et al, 1994a,b). Cadences in our patients are higher (Murray et al, 1978;Stern et al, 1983;Marini et al, 1992), but also lower than those in other studies (Pedersen et al, 1991).…”

“…Only few gait studies (Morris et al, 1994a,b), such as ours, adhere to currently accepted clinical criteria (Gibb and Lees, 1988). Other reports mention correspondent criteria (Murray et al, 1978;Bowes et al, 1990;Blin et al, 1990a;Miller et al, 1996), while some authors do not at all define the Parkinsonism in their probands (Pedersen et al, 1991;Weller et al, 1992Weller et al, , 1993.…”

“…First, some reports testing drug effects on stride parameters in PD did not present control data (Bowes et al, 1990;Pedersen et al, 1991;Blin et al, 1991;Weller et al, 1993). Other authors took control data from earlier literature to evaluate gait in their own Parkinsonian patients (Knutsson, 1972;Stern et al, 1983;Forssberg, 1984;Delwaide and Delmotte, 1989).…”

Effect of captopril on functional, physiological and biochemical outcome criteria in aged heart failure patients.

“…Gait was recorded for 30 s, if 20 m had not been covered in this time. The time course of any reduction of stride length towards the end of the walk was defined using the cone method (Bowes et al, 1990), and such termination of gait artefacts were eliminated. Three measures of gait were analysed, free walking speed, mean stride length and mean double support time (the time during which weight is borne on both feet between successive strides).…”

Advances in Therapeutic Options for Gait and Balance in Parkinson’s Disease

“…The majority of postural control and gait impairments associated with falls are resistant to dopaminergic treatment. 17 While some gait parameters, including stride length, gait velocity, and movement amplitudes, improve with dopaminergic treatment, 6,[18][19][20][21] other features, including temporal parameters (e.g. cadence, swing and stance duration), kinetic abnormalities, and gait variability are treatment resistant.…”