Gait Disturbances in Parkinson’s Disease

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Abstract

Gait disturbances have recently been added as the fifth cardinal motor symptom of parkinsonism. This addition was made due to the unique phenomenology of gait disturbances (e.g., in the form of freezing and festination) and their importance in the clinical spectrum of parkinsonism. In his famous “Essay on Shaking Palsy”, James Parkinson first elegantly described how the parkinsonian patient is “irresistibly impelled to make much quicker and shorter steps, and thereby to adopt unwillingly a running pace...”. Gait disturbances, like decreased arm swing, slower speed, and shorter steps appear early in the course of Parkinson’s disease (PD), sometimes even as presenting symptoms. From the functional point of view, however, gait abnormalities are of clinical significance mainly in the advanced stages of the disease. With the current, modern treatment of PD, patients are able to maintain locomotion longer, but this is accompanied by motor response fluctuations and dyskinesias. “Off” state akinesia, severe lethargy, light headedness and dystonic postures of the legs or trunk and “on” state dyskinesias have created a new type of gait disturbance that was not seen prior to the levodopa era. Gait disturbances in PD exert profound effects on function and independence and haverecently been shown to be a major risk factor for institutionalization and death in patients with PD (Hely et al 1999).