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Postural instability and fall risk in Parkinson’s disease: impaired dual tasking, pacing, and bilateral coordination of gait during the “ON” medication state

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Abstract

The interplay between gait and specific cognitive faculties, in particular executive function (EF) and dual tasking abilities, has been described in healthy adults and in patients with Parkinson’s disease (PD). There is, however, little direct evidence on the relationship between cognitive function, gait, and fall risk in PD, especially in the “ON” state (i.e., under the influence of the anti-parkinsonian medications). To address this issue, we evaluated cognitive function and gait under usual walking and dual-task conditions in 30 patients with PD in the ON state of the medication cycle. Subjects were classified as fallers or non-fallers based on their history. A computerized battery quantified cognitive function. Gait was assessed under three conditions: (1) Usual walking, (2) While subtracting serial 3 s, and (3) While subtracting serial 7 s. The EF and attention scores were lower in the fallers, compared to non-fallers (P ≤ 0.037), but general measures of cognition, e.g., memory, (P = 0.341) were not. Gait speed, variability, and the bilateral coordination of gait were worse in the fallers in all conditions. The DT effects on gait variability and bilateral coordination were larger in the fallers (P = 0.044, P = 0.061, respectively). These results suggest that patients with PD who have a high risk of falling are more sensitive to DT effects, perhaps as a result of relatively poor EF. These cognitive and motor deficits may increase the likelihood of loss of balance during everyday attention-demanding tasks among patients with PD.

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Acknowledgments

We thank the patients and staff of the Movement Disorders Unit at the Tel Aviv Sourasky Medical Center for invaluable assistance. We thank Dr. Jennifer Srygley and Mr. Leor Grundlinger for their help with data handling. This study was supported in part by grants from the Tel Aviv Sourasky Medical Center Grant of Excellence, by the Parkinson’s disease Foundation (PDF), the National Parkinson’s Foundation (NPF) and by the Israeli Ministries of Health and Veteran Affairs (Grant #3000004385). M. Plotnik acknowledges Dr. Jay Goldberg for inspiring his scientific work.

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Authors and Affiliations

  1. Laboratory for Gait and Neurodynamics, Movement Disorders Unit, Department of Neurology, Tel Aviv Sourasky Medical Center, 6 Weizmann St., 64239, Tel Aviv, Israel

    Meir Plotnik, Nir Giladi, Yaacov Dagan & Jeffery M. Hausdorff

  2. Department of Physiology, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel

    Meir Plotnik

  3. The Gonda Brain Research Center, Bar Ilan University, Ramat Gan, Israel

    Meir Plotnik

  4. Department of Physical Therapy, Sheba Medical Center, Ramat Gan, Israel

    Yaacov Dagan

  5. Department of Neurology, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel

    Nir Giladi

  6. Department of Physical Therapy, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel

    Jeffery M. Hausdorff

  7. Department of Medicine, Harvard Medical School, Boston, USA

    Jeffery M. Hausdorff

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  1. Meir Plotnik
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  2. Nir Giladi
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  4. Jeffery M. Hausdorff
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Correspondence to Meir Plotnik.

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Plotnik, M., Giladi, N., Dagan, Y. et al. Postural instability and fall risk in Parkinson’s disease: impaired dual tasking, pacing, and bilateral coordination of gait during the “ON” medication state. Exp Brain Res 210, 529–538 (2011). https://doi.org/10.1007/s00221-011-2551-0

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  • DOI: https://doi.org/10.1007/s00221-011-2551-0

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