Medication improves balance and complex gait performance in Parkinson disease

Abstract

Gait and balance impairments in people with Parkinson disease (PD) may lead to falls and serious injuries. Therefore, it is critical to improve our understanding of the nature of these impairments, including how they respond to prescribed anti-Parkinson medication. This is particularly important for complex balance and gait tasks that may be associated with falls. We evaluated motor function, functional balance, and gait performance during various gait tasks in 22 people with PD OFF and ON medication (PD OFF, PD ON) and 20 healthy older adults. Although MDS-UPDRS-III score, Berg Balance Scale, Mini-Balance Evaluations Systems test, and Timed-Up-and-Go improved in PD with medication, impairments persisted in all measures on medication, compared to controls. Dual task Timed-Up-and-Go did not improve with medication, and PD ON required more time than controls. Gait velocity and stride length improved similarly with medication in PD across forward, fast, backward, dual task forward, and dual task backward gait tasks. Cadence did not change with medication, nor did it differ between PD ON and controls. Velocity and stride length were reduced in PD ON compared to controls. Velocity reductions in PD ON during fast gait were cadence-mediated, while velocity reductions in backward gait were stride length-mediated. Our results suggest functional balance improves with medication in PD and gait performance improves with medication, regardless of task complexity. Remaining impairments on medication highlight the need to examine additional therapeutic options for individuals with PD to reduce the risk of falls.

Figure 1

Balance and Functional measures including BBS (A), mini-BESTest (B), TUG (C), and DT-TUG (D) are compared between PD OFF and ON medication, as well as between PD ON and Controls. BBS, mini-BESTest, and TUG improved in PD with medication. Impairments were detected in all measures in PD ON compared to Controls. Error Bars are SD. *p≤0.05, **p≤0.01, ***p≤0.001.

Figure 2

Frequency distribution of scores for the BBS (A) and mini-BESTest (B) are shown for PD OFF, PD ON, and Controls. Scores on the BBS tended to cluster at the upper end of the range for all groups, compared to the more normal distribution in mini-BESTest scores, suggesting the possibility of ceiling effects with the BBS.

Figure 3

Gait analyses compared gait velocity (A), stride length (B), and cadence (C) between PD OFF and ON medication, as well as between PD ON and Controls. Velocity and stride length improved with medication in PD, while cadence did not change. Velocity and stride length were impaired in PD ON vs. Controls. Impairments in Bkd and DT-Bkd velocity in PD ON vs. Controls were likely mediated by reduced stride length, while deficits in Fast velocity were likely mediated by reduced cadence. Error Bars are SD, * indicates p<0.05.