Peripheral neuropathy in Parkinson’s disease: prevalence and functional impact on gait and balance

Abstract

Peripheral neuropathy is a common problem in patients with Parkinson’s disease. Peripheral neuropathy’s prevalence in Parkinson’s disease varies between 4.8% - 55%, compared to 9% in the general population. It remains unclear whether peripheral neuropathy leads to decreased motor performance in Parkinson’s disease, resulting in impaired mobility and increased balance deficits. We aimed to determine the prevalence and type of peripheral neuropathy in Parkinson’s disease patients, and evaluate its functional impact on gait and balance. A cohort of consecutive Parkinson’s disease patients assessed by Movement Disorders’ specialists based on the UK Brain Bank criteria underwent clinical, neurophysiological (nerve conduction studies and Quantitative Sensory Testing) and neuropathological (Intraepidermal nerve fiber density in skin biopsies’ punches) evaluation, to characterize peripheral neuropathy’s type and etiology with a cross-sectional design. Gait and balance were characterized using wearable health-technology at OFF and ON medication states and the main parameters were extracted using validated algorithms. A total of 99 Parkinson’s disease participants with a mean age of 67.2 (±10) years-old and mean disease duration of 6.5 (±5) years were assessed. Based on a comprehensive clinical, neurophysiological and neuropathological evaluation we found that 40.4% of Parkinson’s disease patients presented peripheral neuropathy, with a predominance of small fiber neuropathy (70% of the group). At OFF state, the presence of peripheral neuropathy was significantly associated with shorter stride length (P = 0.029), slower gait speed (P = 0.005) and smaller toe-off angles (P = 0.002) during straight walking; significantly slower speed (P = 0.019) and smaller toe-off angles (P = 0.007) were also observed during circular walking. At ON state, the above effects remained, albeit moderately reduced. With regard to balance, significant differences between Parkinson’s disease patients with and without peripheral neuropathy were observed at OFF medication state during stance with closed eyes on a foam surface. At ON states, these differences were no longer observable. We showed that peripheral neuropathy is common in Parkinson’s disease, and influences gait and balance parameters, as measured with mobile health-technology. Our study supports that peripheral neuropathy recognition and directed treatment should be pursued in order to improve Parkinson’s disease patient’s gait and minimize balance related disability, targeting individualized medical care.

Incongruity of Geometric and Spectral Markers in the Assessment of Body Sway

“…Our understanding of the control of standing and its fragility would be likely improved by exploiting compliant surfaces. It is good that patients can easily be put on Foam (169)(170)(171)(172)(173), and the safety harness would not alter their behaviour (174).…”

No Evidence of Sensory Neuropathy in a Traditional Mouse Model of Idiopathic Parkinson’s Disease

“…Incorporating sensory assessments alongside traditional motor assessments can provide a more complete picture of the disease, especially as counts of intraepidermal nerve fibres decline as PD progresses [60]. Interestingly, sensory neuronal impairment may explain, in part, some of the motor deficits in PD [61]. Additionally, sensory deficits are important prior to disease: skin complaints rise in the years prior to the diagnosis of PD [5] and peripheral neuropathy is observed in PD patients at diagnosis [62].…”

Small fiber neuropathies: expanding their etiologies

“…The term syndromic SFN is used when small fiber pathology is present without the typical neuropathic features of SFN [5]. In neurogenerative diseases, like Parkinson's disease or multiple system atrophy, a reduced IENFD and abnormal quantitative sensory testing have been described [29 ▪ ,30 ▪ ,31 ▪ ]. In a study evaluating 59 Parkinson's disease patients, a decreased IENFD was negatively correlated with an autonomic symptom questionnaire [29 ▪ ].…”