Framework for understanding balance dysfunction in Parkinson's disease

Schoneburg, Bernadette; Mancini, Martina; Horak, Fay B.; Nutt, John G.

doi:10.1002/mds.25613

Cited by 196 publications

(206 citation statements)

References 93 publications

(127 reference statements)

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“…This suggests that postural responses are complex phenomena. Although ability to take large steps and step quickly are significant contributors, deficits in proprioceptive integration and response scaling (23), impaired sense of vertical (5,24), asymmetry in balance control (6), or impairments in executive function (5,25) probably also contribute to postural impairments. The correlational results were comparable for the full sample and for the sub-groups of freezers and non-freezers.…”

Section: Discussionmentioning

confidence: 99%

“…There have been conflicting reports of whether postural responses can be directly altered with training (5,7,23,(30)(31)(32); conversely there is strong evidence to support improvements in gait parameters with a variety of interventions (for review, see (33)). One study found that 2 weeks of training with repeated perturbations not only increased compensatory step length and reduced delay in compensatory step initiation, but also increased stride length and velocity in voluntary gait (31), demonstrating the potential for generalized improvements across both gait and postural responses with targeted training for only 1 of these components.…”

Section: Discussionmentioning

confidence: 99%

“…Postural control deficits are present in both anticipatory and reactive balance tasks (5,6). People with PD exhibit deficits in compensatory stepping after postural perturbation, with smaller step lengths and more steps taken to recover balance (5,7).…”

mentioning

confidence: 99%

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Low to moderate relationships between gait and postural responses in Parkinson disease

Sutter¹,

Seidler²,

Duncan³

et al. 2017

J Rehabil Med

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Low to moderate relationships between gait and postural responses in Parkinson disease

Sutter¹,

Seidler²,

Duncan³

et al. 2017

J Rehabil Med

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“…4 Our cohort consisted primarily of subjects in Hoehn & Yahr stages 1-3 (99.2%) who did not manifest significant festination at the time of study. Unlike festination, slowing of gait speed can be seen even in de novo and early PD, 5,6 which likely reflects early impairments of multisystem neuronal compensatory mechanisms, 7 and appears to signal the presence of cortical cholinergic terminal loss superimposed upon nigrostriatal dopaminergic denervation. 1 Progressive stooping and postural impairments, seen commonly in more severe stages of PD, are likely significant contributors to festinating gait.…”

Section: Higher Glucose Levels Associated With Lower Memory and Reducmentioning

confidence: 99%

Gait speed in Parkinson disease correlates with cholinergic degeneration

Landau¹,

Bohnen²,

Kotagal³

et al. 2014

Neurology

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et al. 1 attempted to establish an association between glucose metabolism and memory performance. They concluded that higher blood glucose levels negatively influenced cognition. We believe that the design and methodology is inadequate to draw these conclusions.The bivariate approaches do not consider that confounding factors might be related to both glucose metabolism and memory (e.g., age). The hippocampus as a potential mediator is stated to lose significance upon adjustment for even the most basic confounders. Presenting raw and adjusted models would allow the assessment of the role of confounders.In addition, we could not interpret the standardized regression coefficients for sex as a dichotomous trait. Measures of precision (e.g., confidence intervals [CIs]) for associations were not reported. To translate the authors' results to real-world quantities, we do not see how to use many significant test results without adjustment for multiple testing. We were not able to derive a meaningful adjusted measure of association between HbA1c and the presented memory tests.The authors should provide a comprehensible magnitude adjusted for potential confounders, for example: "5 mmol/mol higher HbA1c levels were associated with an average of 1.5 (0.5-3.0) fewer words remembered in the delayed recall test."Author Response: Lucia Kerti, A. Veronica Witte, Ulrike Grittner, Agnes Floeel, Berlin: The authors thank Drs. Grabenhenrich and Roll for their comments. We reported significant associations of markers of glucose metabolism with memory performance in 141 older adults.1 In addition to bivariate analyses, we reported adjusted multiple regression models, which were controlled for confounding factors including age and sex using a stepwise selection method.We have conducted alternative models using the "enter" method for age and sex variables and obtained similar results to those we reported, thus supporting our original conclusions. HbA1c remained significantly associated with the primary outcome (delayed recall) and the other 2 subtests of memory performance (p , 0.05). If a Bonferroni correction for multiple testing is applied, the associations between HbA1c and delayed recall and between HbA1c and learning ability remained significant. According to the regression model, a difference in HbA1c levels of 5 mmol/mol was associated with a reduction of 1.4 remembered words (95% CI 0.4-2.3) in the delayed recall task.In our study, we outlined strengths and weaknesses of a cross-sectional design and highlighted the necessity of future longitudinal trials. A recent epidemiologic survey of glucose levels and dementia revealed that higher glucose levels may be a risk factor for dementia, even in those without diabetes.

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“…Pharmacological research suggests that poor balance in this population is due to malfunctioning afferent sensory integration and decreased 5,6 efferent neuromuscular signals in the central nervous system (CNS). However there is also evidence that balance can worsen with these pharmacological interventions, suggesting 2,7 there are other contributors to fall risk in this population.…”

Section: Introductionmentioning

confidence: 99%