Subtle gait and balance impairments occur in idiopathic rapid eye movement sleep behavior disorder

Abstract

Background Although motor abnormalities have been flagged as potentially the most sensitive and specific clinical features for predicting the future progression to Parkinson's disease, little work has been done to characterize gait and balance impairments in idiopathic rapid eye movement sleep behavior disorder (iRBD). Objective The objective of this study was to quantitatively determine any static balance as well as gait impairments across the 5 independent domains of gait in polysomnography‐confirmed iRBD patients using normal, fast‐paced, and dual‐task walking conditions. Methods A total of 38 participants (24 iRBD, 14 healthy controls) completed the following 5 different walking trials across a pressure sensor carpet: (1) normal pace, (2) fast pace, (3) while counting backward from 100 by 1s, (4) while naming as many animals as possible, (5) while subtracting 7s from 100. Results Although no gait differences were found between the groups during normal walking, there were significant differences between groups under the fast‐paced and dual‐task gait conditions. Specifically, in response to the dual tasking, healthy controls widened their step width without changing step width variability, whereas iRBD patients did not widen their step width but, rather, significantly increased their step width variability. Similarly, changes between the groups were observed during fast‐paced walking wherein the iRBD patients demonstrated greater step length asymmetry when compared with controls. Conclusions This study demonstrates that iRBD patients have subtle gait impairments, which likely reflect early progressive degeneration in brainstem regions that regulate both REM sleep and gait coordination. Such gait assessments may be useful as a diagnostic preclinical screening tool for future fulminant gait abnormalities for trials of disease‐preventive agents. © 2019 International Parkinson and Movement Disorder Society

Instrumental Analysis of Gait Abnormalities in Idiopathic Rapid Eye Movement Sleep Behavior Disorder

“…Based on a comparable quantitative analysis and almost 3 times greater pool of iRBD patients, we were not able to confirm the subtle gait abnormalities during dual‐tasking reported by Ehgoetz Martens and colleagues even though we investigated both motor and cognitive dual‐task conditions. In agreement with Ehgoetz Martens and colleagues, we did not uncover any significant differences in gait during regular walking in our iRBD cohort, which is in contrast to the previous study reporting numerous gait deficits during normal walking in 42 probable RBD patients and 492 controls . We also did not find any effect of interference between the single‐task and dual‐task test, which was not yet investigated.…”

“…We read with great interest the article by Ehgoetz Martens and colleagues showing subtle gait differences in idiopathic rapid eye movement sleep behavior disorder (iRBD) patients under the fast‐paced and cognitive dual‐task conditions. Although the results appear to be promising, they are based on a relatively small sample of 24 iRBD patients compared with 14 healthy controls . In contrast, our data obtained in a larger population of iRBD patients do not confirm the findings of early gait abnormalities.…”

“…As a control group, 40 healthy participants (34 men) without a history of neurological disorders were included. Gait analysis was performed using a sensor carpet (GaitRite) consistently with the original study . We employed a single‐task, motor dual‐task (carrying a glass of water), and cognitive dual‐task (serially subtracting 3 from 100, with no task prioritization) extended Timed Up & Go test.…”

“…For adequate comparability, here we show only preturn gait segment. Similarly to Ehgoetz Martens and colleagues, we investigated gait velocity, step length, step time, step‐time asymmetry, and their variability, but also added standard measures of gait‐cycle time, swing, stance, single support time, and double support time. In addition, interference for nonasymmetric measures was calculated .…”

Education Moderates the Association of Probable REM Sleep Behavior Disorder With Cognitive and Motor Impairments in Community-Dwelling Older People

“…This relationship between pRBD and cognitive/motor function is potentially modified by an individual's educational level. The association between RBD, cognitive deficits, and motor abnormalities has been well-recognized, but previous studies mostly focused on PSG-confirmed RBD cases in clinical settings (25)(26)(27). However, RBD patients in clinical settings could have a more severe form of RBD, hence could present entirely different characteristics from the general population, which has been least studied.…”