Modern views on gait impairment in Parkinson`s disease and its correction

Abstract

The article reviews the causes of gait impairment in patients with Parkinson's disease (PD). The emphasis is made on modern ideas, according to which gait impairment in PD is caused by a multisystem lesion and non-dopaminergic dependent mechanisms play the leading role. It is highlighted that gait impairment in PD is associated with the disruption of frontal/subcortical neural pathways which requires a special approach to pharmacological and non-pharmacological therapy. Based on pathogenetic mechanisms, much attention is paid to anti-dementia medications. Attention is drawn to the fact that the use of memantine hydrochloride (akatinol memantine) is a promising direction for gait impairment correction in the advanced and late stages of PD due to the improvement of glutamatergic transfer from the striatum to the specific areas of the cerebral cortex involved in gait control. The results of the latest clinical trials are analyzed.

Cerebral glucose metabolism and cognitive impairment in tremor-dominant and akinetic-rigid subtypes of Parkinson’s disease

“…Bohnen и соавт. [20] Расстройства процессов контроля движений высшего уровня особенно ярко проявляются в случаях смены одной двигательной программы на другую, что отражает дефект планирования, за который отвечает лобная доля [23]. Поражение лобно-подкорковых путей у пациентов с БП проявляется дизрегуляцией когнитивных функций и ПН.…”

“…GMR in the frontal areas (right BA 6,8,9,46 and left BA 46) was lower in the AR group that in the TD one (p<0.05). The severity of CI in the AR group correlated with GMR in the parietal and posterior cingulate cortex (BA 7,23,26,29,30,and 31). The TD group showed correlations of the values of cognitive tests mainly with GMR in the frontal and anterior cingulate cortex (BA 6,(8)(9)(10)(11)24), and in the parietal (BA 7) and temporal cortices (BA 22).…”