, 36:9678

Contributions of mild parkinsonian signs to gait performance in the elderly

  • Gilles Allali
  • Joe Verghese
  • Jeannette R. Mahoney


Mild parkinsonian signs (MPS) and gait abnormalities are common in aging, but the association between MPS and objective gait measures is not established in the elderly. This study aims to identify the link between MPS and quantitative gait measures, as well as to determine the pathogenesis of MPS in non-demented community-dwelling older adults without idiopathic Parkinson’s disease or other parkinsonian syndromes. Three hundred seventy-four non-demented older adults (mean age, 76.44 ± 6.71 years, 57 % women) participated in this study, where comprehensive neurological and medical assessments were conducted. We defined MPS based on the presence of any one of bradykinesia, rigidity, or rest tremor. Velocity and spatial, temporal, and variability gait parameters were recorded using an instrumented walkway. The associations of MPS and gait parameters as well as the relationship of individual MPS with medical illnesses were assessed with linear regressions controlling for key covariates. Participants with MPS walked slower and with disturbed spatial and variability components of gait compared to those without MPS. Bradykinesia was associated with worse spatial and variability gait parameters. This association was only significant for axial bradykinesia, but not for the presence of bradykinesia in the limbs. Cerebrovascular disease (β = .20, p < .01) was associated with bradykinesia, whereas cardiovascular disease (β = .15, p < .05) was associated with rigidity. Among MPS, bradykinesia but not rigidity or tremor was associated with worse quantitative gait performance in older adults. Cerebrovascular disease, a preventable condition, was specifically associated with bradykinesia.


Gait Aging Mild parkinsonian signs Cerebrovascular disease 


  1. Ambrose A, Levalley A, Verghese J (2006) A comparison of community-residing older adults with frontal and parkinsonian gaits. J Neurol Sci 248(1–2):215–218. doi:10.1016/j.jns.2006.05.035 PubMedCrossRefGoogle Scholar
  2. Bennett DA, Beckett LA, Murray AM, Shannon KM, Goetz CG, Pilgrim DM, Evans DA (1996) Prevalence of parkinsonian signs and associated mortality in a community population of older people. N Engl J Med 334(2):71–76. doi:10.1056/NEJM199601113340202 PubMedCrossRefGoogle Scholar
  3. Blin O, Ferrandez AM, Pailhous J, Serratrice G (1991) Dopa-sensitive and dopa-resistant gait parameters in Parkinson's disease. J Neurol Sci 103(1):51–54PubMedCrossRefGoogle Scholar
  4. Boyle PA, Wilson RS, Aggarwal NT, Arvanitakis Z, Kelly J, Bienias JL, Bennett DA (2005) Parkinsonian signs in subjects with mild cognitive impairment. Neurology 65(12):1901–1906. doi:10.1212/01.wnl.0000188878.81385.73 PubMedCrossRefGoogle Scholar
  5. Buchman AS, Shulman JM, Nag S, Leurgans SE, Arnold SE, Morris MC, Schneider JA, Bennett DA (2012) Nigral pathology and parkinsonian signs in elders without Parkinson disease. Ann Neurol 71(2):258–266. doi:10.1002/ana.22588 PubMedCentralPubMedCrossRefGoogle Scholar
  6. Camicioli R, Bouchard T, Licis L (2006) Dual-tasks and walking fast: relationship to extra-pyramidal signs in advanced Alzheimer disease. J Neurol Sci 248(1–2):205–209. doi:10.1016/j.jns.2006.05.013 PubMedCrossRefGoogle Scholar
  7. de Laat KF, van Norden AG, Gons RA, van Oudheusden LJ, van Uden IW, Bloem BR, Zwiers MP, de Leeuw FE (2010) Gait in elderly with cerebral small vessel disease. Stroke J Cereb Circ 41(8):1652–1658. doi:10.1161/strokeaha.110.583229 CrossRefGoogle Scholar
  8. de Laat KF, van Norden AG, Gons RA, van Uden IW, Zwiers MP, Bloem BR, van Dijk EJ, de Leeuw FE (2012) Cerebral white matter lesions and lacunar infarcts contribute to the presence of mild parkinsonian signs. Stroke J Cereb Circ 43(10):2574–2579. doi:10.1161/strokeaha.112.657130 CrossRefGoogle Scholar
  9. Domellof ME, Elgh E, Forsgren L (2011) The relation between cognition and motor dysfunction in drug-naive newly diagnosed patients with Parkinson's disease. Mov Disord Off J Mov Disord Soc 26(12):2183–2189. doi:10.1002/mds.23814 CrossRefGoogle Scholar
  10. Duff K, Humphreys Clark JD, O'Bryant SE, Mold JW, Schiffer RB, Sutker PB (2008) Utility of the RBANS in detecting cognitive impairment associated with Alzheimer's disease: sensitivity, specificity, and positive and negative predictive powers. Arch Clin Neuropsychol Off J Natl Acad Neuropsychol 23(5):603–612. doi:10.1016/j.acn.2008.06.004 CrossRefGoogle Scholar
  11. Fahn S, Elton R (1987) Unified Parkinson's Disease Rating Scale. MacMillan Healthcare Information, Florham ParkGoogle Scholar
  12. Fleischman DA, Wilson RS, Bienias JL, Bennett DA (2005) Parkinsonian signs and cognitive function in old age. J Int Neuropsychol Soc 11(5):591–597. doi:10.1017/S1355617705050708 PubMedGoogle Scholar
  13. Fleischman DA, Wilson RS, Schneider JA, Bienias JL, Bennett DA (2007) Parkinsonian signs and functional disability in old age. Exp Aging Res 33(1):59–76. doi:10.1080/03610730601006370 PubMedCrossRefGoogle Scholar
  14. Grabli D, Karachi C, Welter ML, Lau B, Hirsch EC, Vidailhet M, Francois C (2012) Normal and pathological gait: what we learn from Parkinson's disease. J Neurol Neurosurg Psychiatry 83(10):979–985. doi:10.1136/jnnp-2012-302263 PubMedCrossRefGoogle Scholar
  15. Holtzer R, Goldin Y, Zimmerman M, Katz M, Buschke H, Lipton RB (2008) Robust norms for selected neuropsychological tests in older adults. Arch Clin Neuropsychol Off J Natl Acad Neuropsychol 23(5):531–541. doi:10.1016/j.acn.2008.05.004 CrossRefGoogle Scholar
  16. Holtzer R, Wang C, Verghese J (2014) Performance variance on walking while talking tasks: theory, findings, and clinical implications. Age (Dordrecht, Netherlands) 36(1):373–381. doi:10.1007/s11357-013-9570-7 CrossRefGoogle Scholar
  17. Louis ED, Bennett DA (2007) Mild Parkinsonian signs: An overview of an emerging concept. Mov Disord Off J Mov Disord Soc 22(12):1681–1688. doi:10.1002/mds.21433 CrossRefGoogle Scholar
  18. Louis ED, Tang MX, Mayeux R (2004) Parkinsonian signs in older people in a community-based study: risk of incident dementia. Arch Neurol 61(8):1273–1276. doi:10.1001/archneur.61.8.1273 PubMedCrossRefGoogle Scholar
  19. Louis ED, Schupf N, Manly J, Marder K, Tang MX, Mayeux R (2005a) Association between mild parkinsonian signs and mild cognitive impairment in a community. Neurology 64(7):1157–1161. doi:10.1212/01.WNL.0000156157.97411.5E PubMedCrossRefGoogle Scholar
  20. Louis ED, Tang MX, Schupf N, Mayeux R (2005b) Functional correlates and prevalence of mild parkinsonian signs in a community population of older people. Arch Neurol 62(2):297–302. doi:10.1001/archneur.62.2.297 PubMedCrossRefGoogle Scholar
  21. Louis ED, Schupf N, Marder K, Tang MX (2006) Functional correlates of mild parkinsonian signs in the community-dwelling elderly: poor balance and inability to ambulate independently. Mov Disord Off J Mov Disord Soc 21(3):411–416. doi:10.1002/mds.20735 CrossRefGoogle Scholar
  22. Louis ED, Tang MX, Schupf N (2010) Mild parkinsonian signs are associated with increased risk of dementia in a prospective, population-based study of elders. Mov Disord Off J Mov Disord Soc 25(2):172–178. doi:10.1002/mds.22943 CrossRefGoogle Scholar
  23. Maillet A, Pollak P, Debu B (2012) Imaging gait disorders in parkinsonism: a review. J Neurol Neurosurg Psychiatry 83(10):986–993. doi:10.1136/jnnp-2012-302461 PubMedCrossRefGoogle Scholar
  24. Morris ME, Iansek R, Matyas TA, Summers JJ (1994) The pathogenesis of gait hypokinesia in Parkinson's disease. Brain: J Neurol 117(Pt 5):1169–1181CrossRefGoogle Scholar
  25. Murray AM, Bennett DA, Mendes de Leon CF, Beckett LA, Evans DA (2004) A longitudinal study of parkinsonism and disability in a community population of older people. J Gerontol A: Biol Med Sci 59(8):864–870CrossRefGoogle Scholar
  26. Pirker W (2003) Correlation of dopamine transporter imaging with parkinsonian motor handicap: how close is it? Mov Disord Off J Mov Disord Soc 18(Suppl 7):S43–S51. doi:10.1002/mds.10579 CrossRefGoogle Scholar
  27. Richards M, Stern Y, Marder K, Cote L, Mayeux R (1993) Relationships between extrapyramidal signs and cognitive function in a community-dwelling cohort of patients with Parkinson's disease and normal elderly individuals. Ann Neurol 33(3):267–274. doi:10.1002/ana.410330307 PubMedCrossRefGoogle Scholar
  28. Schaafsma JD, Giladi N, Balash Y, Bartels AL, Gurevich T, Hausdorff JM (2003) Gait dynamics in Parkinson's disease: relationship to Parkinsonian features, falls and response to levodopa. J Neurol Sci 212(1–2):47–53PubMedCrossRefGoogle Scholar
  29. Staekenborg SS, van der Flier WM, van Straaten EC, Lane R, Barkhof F, Scheltens P (2008) Neurological signs in relation to type of cerebrovascular disease in vascular dementia. StrokeJ Cereb Circ 39(2):317–322. doi:10.1161/STROKEAHA.107.493353 CrossRefGoogle Scholar
  30. Stolze H, Kuhtz-Buschbeck JP, Drucke H, Johnk K, Illert M, Deuschl G (2001) Comparative analysis of the gait disorder of normal pressure hydrocephalus and Parkinson's disease. J Neurol Neurosurg Psychiatry 70(3):289–297PubMedCentralPubMedCrossRefGoogle Scholar
  31. Uemura Y, Wada-Isoe K, Nakashita S, Nakashima K (2013) Depression and cognitive impairment in patients with mild parkinsonian signs. Acta Neurol Scand 128(3):153–159. doi:10.1111/ane.12089 PubMedCrossRefGoogle Scholar
  32. Verghese J, Lipton RB, Hall CB, Kuslansky G, Katz MJ, Buschke H (2002) Abnormality of gait as a predictor of non-Alzheimer's dementia. N Engl J Med 347(22):1761–1768PubMedCrossRefGoogle Scholar
  33. Verghese J, Lipton RB, Katz MJ, Hall CB, Derby CA, Kuslansky G, Ambrose AF, Sliwinski M, Buschke H (2003) Leisure activities and the risk of dementia in the elderly. N Engl J Med 348(25):2508–2516PubMedCrossRefGoogle Scholar
  34. Verghese J, Kuslansky G, Holtzer R, Katz M, Xue X, Buschke H, Pahor M (2007a) Walking while talking: effect of task prioritization in the elderly. Arch Phys Med Rehabil 88(1):50–53. doi:10.1016/j.apmr.2006.10.007 PubMedCentralPubMedCrossRefGoogle Scholar
  35. Verghese J, Wang C, Lipton RB, Holtzer R, Xue X (2007b) Quantitative gait dysfunction and risk of cognitive decline and dementia. J Neurol Neurosurg Psychiatry 78(9):929–935. doi:10.1136/jnnp.2006.106914 PubMedCentralPubMedCrossRefGoogle Scholar
  36. Verghese J, Holtzer R, Lipton RB, Wang C (2009) Quantitative gait markers and incident fall risk in older adults. J Gerontol A: Biol Med Sci 64(8):896–901. doi:10.1093/gerona/glp033 CrossRefGoogle Scholar
  37. Yesavage JA, Brink TL, Rose TL, Lum O, Huang V, Adey M, Leirer VO (1982) Development and validation of a geriatric depression screening scale: a preliminary report. J Psychiatr Res 17(1):37–49PubMedCrossRefGoogle Scholar

Copyright information

© American Aging Association 2014

Authors and Affiliations

  • Gilles Allali
    • 1
    • 2
  • Joe Verghese
    • 1
  • Jeannette R. Mahoney
    • 1
    • 3
  1. 1.Department of Neurology, Division of Cognitive & Motor Aging, Albert Einstein College of MedicineYeshiva UniversityBronxUSA
  2. 2.Department of Clinical Neurosciences, Geneva University HospitalsUniversity of GenevaGenevaSwitzerland
  3. 3.Albert Einstein College of MedicineYeshiva UniversityBronxUSA

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