Arm swing as a potential new prodromal marker of Parkinson's disease

Abstract

Background Reduced arm swing is a well-known clinical feature of Parkinson’s disease (PD), often observed early in the course of the disease. We hypothesized that subtle changes in arm swing and axial rotation may also be detectable in the prodromal phase. Objective The purpose of this study was to evaluate the relationship between the LRRK2-G2019S mutation, arm swing, and axial rotation in healthy nonmanifesting carriers and noncarriers of the G2019S mutation and in patients with PD. Methods A total of 380 participants (186 healthy nonmanifesting controls and 194 PD patients) from 6 clinical sites underwent gait analysis while wearing synchronized 3-axis body-fixed sensors on the lower back and bilateral wrists. Participants walked for 1 minute under the following 2 conditions: (1) usual walking and (2) dual-task walking. Arm swing amplitudes, asymmetry, variability, and smoothness were calculated for both arms along with measures of axial rotation. Results A total of 122 nonmanifesting participants and 67 PD patients were carriers of the G2019S mutation. Nonmanifesting mutation carriers walked with greater arm swing asymmetry and variability and lower axial rotation smoothness under the dual task condition when compared with noncarriers (P < .04). In the nonmanifesting mutation carriers, arm swing asymmetry was associated with gait variability under dual task (P = .003). PD carriers showed greater asymmetry and variability of movement than PD noncarriers, even after controlling for disease severity (P < .009). Conclusions The G2019S mutation is associated with increased asymmetry and variability among nonmanifesting participants and patients with PD. Prospective studies should determine if arm swing asymmetry and axial rotation smoothness may be used as motor markers of prodromal PD.

Loss of gait control assessed by cognitive-motor dual-tasks: pros and cons in detecting people at risk of developing Alzheimer’s and Parkinson’s diseases

“…Specifically, voice and face akinesia seem to be the first signs to appear (estimated prodromal interval: 9.8 years), followed by rigidity (4.4 years), gait abnormalities (4.4 years), and limb bradykinesia (4.2 years). As regards gait changes, these findings suggest that patients with early PD should present subtle gait disorders (Panyakaew and Bhidayasiri 2013;Mirelman et al 2016). Yet, they are not detectable under undisturbed walking conditions (i.e., self-selected comfortable speed under single-task condition) in the prodromal phase.…”

“…While prodromal non-motor symptoms (e.g., mood disorders and olfaction) are largely explored, motor symptoms, on the other hand, remain poorly studied. However, because PD is currently diagnosed by its motor features, it is reasonable to speculate that subtle changes in the motor function will be present before the appearance of the cardinal motor signs required for diagnosis (Mirelman et al 2016). In line with this view, Postuma et al (2012) suggested that the stage when idiopathic rapid eye movement (REM) sleep behavior disorder (i.e., characterized by vivid, oftenfearful dreams, and loss of normal muscle atonia during rapid eye movement sleep) (Olson et al 2000) is diagnosed may provide a window to better understand prodromal motor symptoms.…”

“…The challenge remains about how to capture these gait disorders despite compensatory capabilities? An intriguing possibility, which has recently been envisioned by very few studies (Lerche et al 2014;Mirelman et al 2011Mirelman et al , 2016, is that dual-task walking may serve as a new, sensitive prodromal marker of PD.…”

“…Such disorders include (i) decreases in gait speed (Fuller et al 2013;Wild et al 2013;Stegemöller et al 2014;Strouwen et al 2016), stride length (O'Shea et al 2002;Rochester et al 2004;Plotnik et al 2011; (Plotnik et al 2009;Tseng et al 2012;Vervoort et al 2016) and (ii) increases in stride time (Panyakaew and Bhidayasiri 2013;Stegemöller et al 2014), cadence (Rochester et al 2014), stance time (Wild et al 2013), stride width (Stegemöller et al 2014), stride length asymmetry (Rochester et al 2014;Vervoort et al 2016), swing time variability (Stegemöller et al 2014), stride time variability, and stride length variability Yogev et al 2007;Plotnik et al 2009Plotnik et al , 2011Yogev-Seligmann et al 2012;Rochester et al 2014;Stegemöller et al 2014). Decreases in arm swing amplitude and increases in both arm swing asymmetry and arm swing variability have also been documented (Mirelman et al 2016). The few studies that have examined dual-task-related changes in both gait and cognitive performance showed a decline in the two domains (O'Shea et al 2002;Yogev et al 2005).…”

“…There exist three studies that have examined dual-taskrelated gait changes in the prodromal phase of PD (Lerche et al 2014;Mirelman et al 2011Mirelman et al , 2016. All of them have reported dual-task interference during gait.…”