Effect of need to void on Parkinsonian gait

Abstract

Aims: Beside motor control alteration and tremor, the main symptoms in Parkinsonian disorders, lower urinary tract dysfunction is very common and thus often associated with gait disorder. No studies have assessed their association yet. The aim of this study was to assess the effect of the need to void on walking speed in this particular population. The secondary aim was to assess the effect of desire to void in a double task condition on the walking speed, and on the time to raise up from the floor.

Methods: This prospective study included all Parkinsonian disorders who had a follow-up for overactive bladder (OAB). We invited them to drink until a desire to void or equivalent (DV), then they performed three ten-meters walk tests, one double-task ten-meters walk test, one timed-up-and-go test (TUG), one timed raise of the floor (GMT). We repeated the same tests just after bladder emptying.

Results: Nine men and two women (age 69±6) were included in the study (seven Parkinson's Diseases, two multisystem atrophies, two not yet characterized). Mean scores of UPDRS-III were 17±6.5, Hoehn & Yahr scale were 1.9±0.7, time since onset 7±4.4 years, levodopa daily equivalent 691±478mg. Patients performed the walking tests at DV with a mean bladder volume from 220±189mL. The mean speed was 1m/s at DV and 1.1m/s at PV (P<0.001). TUG was also increased for patients at DV: mean 9.8 s at DV versus 8.8sec at PV (P<0.003).

Conclusion: In Parkinsonian disorders, need to void may impact the walking speed, a strong desire to void worsening gait velocity.

Level of evidence: 4.

Keywords: Gait disorders; Lower urinary tract symptoms; Maladie de Parkinson; Parkinsonian disorders; Troubles de la marche; Troubles du bas appareil urinaire.