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. 2023 Jan;16(1):59-67.
doi: 10.14802/jmd.22045. Epub 2022 Sep 7.

Association Between Gait and Dysautonomia in Patients With De Novo Parkinson's Disease: Forward Gait Versus Backward Gait

Seon-Min Lee  1 , Mina Lee  2 , Eun Ji Lee  2 , Rae On Kim  2 , Yongduk Kim  1 , Kyum-Yil Kwon  2
Affiliations

Association Between Gait and Dysautonomia in Patients With De Novo Parkinson's Disease: Forward Gait Versus Backward Gait

Seon-Min Lee et al. J Mov Disord. 2023 Jan.

Abstract

Objective: Studies on gait and autonomic dysfunction have been insufficient so far, particularly de novo Parkinson's disease (PD). The aim of this study was to identify the association between gait dynamics and autonomic dysfunction in patients with de novo PD.

Methods: A total 38 patients with de novo PD were retrospectively included in this study. Details of patients' dysautonomia were assessed using the Scales for Outcomes in Parkinson's Disease-Autonomic Dysfunction (SCOPA-AUT). For assessment of gait, a computerized gait analysis was performed using the GAITRite system for forward gait and backward gait. High SCOPA-AUT score (PD-HSAS) group and low SCOPA-AUT score (PD-LSAS) group were identified according to their SCOPA-AUT scores.

Results: Nineteen (50%) patients with high SCOPA-AUT scores above median value (12.5) were assigned into the PD-HSAS group and others were assigned to the PD-LSAS group. Compared with the PD-LSAS group, the PD-HSAS group exhibited slower gait, shorter stride, decreased cadence, increased double support phase, decreased swing phase, and increased variability in swing time. Total SCOPA-AUT score showed significantly positive correlations with gait variability and instability but a negative correlation with gait hypokinesia. In subdomain analysis, urinary dysautonomia was highly associated with impairment of gait dynamics. All significant results were found to be more remarkable in backward gait than in forward gait.

Conclusion: Our findings suggest that alteration in gait dynamics, especially backward gait, is highly associated with autonomic dysfunction in patients with de novo PD.

Keywords: Backward gait; Gait dynamics; KeywordsaaAutonomic dysfunction; Parkinson’s disease.

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Conflict of interest statement

Conflicts of Interest

The authors have no financial conflicts of interest.

Figures

Figure 1.
Figure 1.
Association between gait hypokinesia and total SCOPA-AUT in patients with de novo PD. A: The total SCOPA-AUT score had no significant correlations with walking speed in the forward gait (rs = -0.290, p = 0.101), but there was a significant positive correlation with walking speed in the backward gait (rs = -0.524, p = 0.002). B: The total SCOPA-AUT score had a negative correlation with stride length (rs = -0.430, p = 0.012; rs = -0.429, p = 0.013) in both the forward gait and backward gait. *p < 0.05. SCOPA-AUT, Scales for Outcomes in Parkinson’s Disease-Autonomic Dysfunction; PD, Parkinson’s disease.
Figure 2.
Figure 2.
Association between gait variability and total SCOPA-AUT in patients with de novo Parkinson’s disease. The total SCOPA-AUT score showed a significantly positive correlation with swing time variability (rs = 0.537, p = 0.001; rs = 0.463, p = 0.007) in both the forward gait and backward gait. *p < 0.05. CV, coefficient of variation; SCOPA-AUT, Scales for Outcomes in Parkinson’s Disease-Autonomic Dysfunction.
Figure 3.
Figure 3.
Association between gait instability and total SCOPA-AUT in patients with de novo Parkinson’s disease. A: The total SCOPA-AUT score had a significantly negative correlation with swing phase (rs = -0.460, p = 0.007; rs = -0.463, p = 0.007) in both forward gait and backward gait. B: The total SCOPA-AUT score had a significantly positive correlation with double support time (rs = 0.409, p = 0.018; rs = 0.497, p = 0.005) in both the forward gait and backward gait. *p < 0.05. SCOPA-AUT, Scales for Outcomes in Parkinson’s Disease-Autonomic Dysfunction.
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