Gait initiation in Parkinson's disease: comparison of timing and displacement during anticipatory postural adjustments as a function of motor severity and apathy in a large cohort

De Waele, Ségolène; Hallemans, Ann; Maréchal, Emke; Cras, Patrick; Crosiers, David

doi:10.1016/j.heliyon.2023.e23740

Cited by 1 publication

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“…Evaluating the coordination and interplay between APA2 and APA1 in individuals with PD can offer critical insights into gait impairments, balance deficits, and the risk of falls. The recent extensive cohort study on PD ( De Waele et al, 2024 ) revealed that individuals with PD experience prolonged GI time after a verbal cue and exhibit increased durations of APA1 and APA2a compared to healthy controls. The extended duration of APA2a implies diminished control during GI, consequently elevating the risk of falls.…”

Section: Discussionmentioning

confidence: 99%

Exploring the role of anticipatory postural adjustment duration within APA2 subphase as a potential mediator between clinical disease severity and fall risk in Parkinson’s disease

Hu,

Lai,

Huang

et al. 2024

Front. Aging Neurosci.

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IntroductionPeople with Parkinson’s Disease (PD) often show reduced anticipatory postural adjustments (APAs) before voluntary steps, impacting their stability. The specific subphase within the APA stage contributing significantly to fall risk remains unclear.MethodsWe analyzed center of pressure (CoP) trajectory parameters, including duration, length, and velocity, throughout gait initiation. This examination encompassed both the postural phase, referred to as anticipatory postural adjustment (APA) (APA1, APA2a, APA2b), and the subsequent locomotor phases (LOC). Participants were instructed to initiate a step and then stop (initiating a single step). Furthermore, we conducted assessments of clinical disease severity using the Unified Parkinson’s Disease Rating Scale (UPDRS) and evaluated fall risk using Tinetti gait and balance scores during off-medication periods.ResultsFreezing of gait (FOG) was observed in 18 out of 110 participants during the measurement of CoP trajectories. The Ramer-Douglas-Peucker algorithm successfully identified CoP displacement trajectories in 105 participants (95.5%), while the remaining 5 cases could not be identified due to FOG. Tinetti balance and gait score showed significant associations with levodopa equivalent daily dose, UPDRS total score, disease duration, duration (s) in APA2a (s) and LOC (s), length in APA1 (cm) and APA2b (cm), mediolateral velocity in APA1 (X) (cm/s), APA2a (X) (cm/s), APA2b (X) (cm/s) and LOC (X) (cm/s), and anterior–posterior velocity in APA2a (Z) (cm/s) and APA2b (Z) (cm/s). Multiple linear regression revealed that only duration (s) in APA2a and UPDRS total score was independently associated with Tinetti gait and balance score. Further mediation analysis showed that the duration (s) in APA2a served as a mediator between UPDRS total score and Tinetti balance and gait score (Sobel test, p = 0.047).ConclusionAPA2 subphase duration mediates the link between disease severity and fall risk in PD, suggesting that longer APA2a duration may indicate reduced control during gait initiation, thereby increasing fall risk.

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Section: Discussionmentioning

confidence: 99%