Experimental Brain Research

, Volume 210, Issue 3, pp 529–538

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

  • Meir Plotnik
  • Nir Giladi
  • Yaacov Dagan
  • Jeffery M. Hausdorff
Research Article

DOI: 10.1007/s00221-011-2551-0

Cite this article as:
Plotnik, M., Giladi, N., Dagan, Y. et al. Exp Brain Res (2011) 210: 529. doi:10.1007/s00221-011-2551-0


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.


Fall risk Parkinson’s disease Gait Cognition Attention 

Copyright information

© Springer-Verlag 2011

Authors and Affiliations

  • Meir Plotnik
    • 1
    • 2
    • 3
  • Nir Giladi
    • 1
    • 5
  • Yaacov Dagan
    • 1
    • 4
  • Jeffery M. Hausdorff
    • 1
    • 6
    • 7
  1. 1.Laboratory for Gait and Neurodynamics, Movement Disorders Unit, Department of NeurologyTel Aviv Sourasky Medical CenterTel AvivIsrael
  2. 2.Department of Physiology, Sackler Faculty of MedicineTel Aviv UniversityTel AvivIsrael
  3. 3.The Gonda Brain Research CenterBar Ilan UniversityRamat GanIsrael
  4. 4.Department of Physical TherapySheba Medical CenterRamat GanIsrael
  5. 5.Department of Neurology, Sackler Faculty of MedicineTel Aviv UniversityTel AvivIsrael
  6. 6.Department of Physical Therapy, Sackler Faculty of MedicineTel Aviv UniversityTel AvivIsrael
  7. 7.Department of MedicineHarvard Medical SchoolBostonUSA

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