Changes in Gait Speed Vary Widely after the Use of Antiparkinson Medication in Persons with Parkinson's Disease

Abstract

Background: Antiparkinson medications are effective in improving Parkinson's disease (PD) motor symptoms such as bradykinesia, tremor, and rigidity. The impact of antiparkinson medication on gait speed is less clear.

Objectives: The primary aim was to determine the effects of antiparkinson medication on gait speed in PD. The secondary aim was to identify characteristics associated with the magnitude of response.

Methods: Two hundred fifty individuals with PD completed the Six-Minute Walk Test on and off medication, on separate days, in a randomized order. A paired t-test and linear regression were used to assess on- to off-medication gait speed differences and their relationships with potential correlates. Using previously established values, changes in gait speed were characterized as small (0.06-0.13 m/s), moderate (0.14-0.21 m/s), and large (>0.22 m/s). Corresponding summary characteristics were provided for each classification.

Results: Mean (standard deviation) gait speed significantly increased from 1.33 (0.31) to 1.40 (0.28) m/s from off to on medication. Longer disease duration, greater clinical ratings of gait and postural instability, slower functional mobility, and higher levodopa equivalent daily dose were associated with larger increases in gait speed. In sum, 131 (52%) participants experienced no improvement or an improvement that did not meet the threshold for small responder. Of the 119 (48%) participants identified as responders, 60 were classified as small, 28 moderate, and 31 large responders.

Conclusions: Overall, gait speed improved with antiparkinson medication; however, individual responses varied. Gait dysfunction in PD may be caused by impairment of multiple neural circuits, some of which are less responsive to antiparkinson medication.

Keywords: Parkinson's disease; Six‐Minute Walk Test; antiparkinson medication; dopamine; gait speed.