The effects of levodopa in the spatiotemporal gait parameters are mediated by self‐selected gait speed in Parkinson's disease

Abstract

In individuals with Parkinson's disease (PD), the medication induces different and inconsistent results in the spatiotemporal parameters of gait, making it difficult to understand its effects on gait. As spatiotemporal gait parameters have been reported to be affected by gait speed, it is essential to consider the gait speed when studying walking biomechanics to interpret the results better when comparing the gait pattern of different conditions. Since the medication alters the self-selected gait speed of individuals with PD, this study analysed whether the change in gait speed can explain the selective effects of L-DOPA on the spatiotemporal parameters of gait in individuals with PD. We analysed the spatiotemporal gait parameters at the self-selected speed of 22 individuals with PD under ON and OFF states of L-DOPA medication. Bayesian mediation analysis evaluated which gait variables were affected by the medication state and checked if those effects were mediated by speed changes induced by medication. The gait speed was significantly higher among ON compared with OFF medication. All the spatiotemporal parameters of the gait were mediated by speed, with proportions of mediation close to 1 (effect entirely explained by speed changes). Our results show that a change in gait speed better explains

3D Kinematics Quantifies Gait Response to Levodopa earlier and to a more Comprehensive Extent than the MDS‐Unified Parkinson's Disease Rating Scale in Patients with Motor Complications

“…This finding contrasts with previous studies, and it is likely attributed to the utilization of a suprathreshold LD dose in this study, which may have been lacking in the later studies. 10,11,14 In this study, a supra-physiologic response was observed for specific features, particularly those related to the upper arms. This observation leads us to believe that this supra-physiologic response likely reflects the presence of dyskinesia, which further reinforces the concept of a heightened susceptibility of the upper limbs to dopamine denervation and replenishment.…”

Prevention of Falls in Parkinson's Disease: Guidelines and Gaps

“…Pharmacological interventions were recently addressed in a Cochrane review 21 . The effectiveness of two classes of non‐dopaminergic medications were examined, as no studies existed on the effects of levodopa on falls risk 77 . Nevertheless, levodopa has been shown to ameliorate some components of gait and balance dysfunction and may mediate fall risk indirectly 17 .…”

“… 21 The effectiveness of two classes of non‐dopaminergic medications were examined, as no studies existed on the effects of levodopa on falls risk. 77 Nevertheless, levodopa has been shown to ameliorate some components of gait and balance dysfunction and may mediate fall risk indirectly. 17 Direct studies of other agents on falls (including dopamine agonists, COMT‐inhibitors, amantadine, rasagiline, selegiline, methylphenidate) did not yield any studies examining falls as a primary outcome.…”

Translating digital healthcare to enhance clinical management: a protocol for an observational study using a digital health technology system to monitor medication adherence and its effect on mobility in people with Parkinson’s

“…At present, research exploring medication and mobility in PwP is typically conducted in controlled lab-based or clinical environments, in specific ON/OFF medication states. [8][9][10][11][12][13][14][15][16] Although some studies have been performed in the real world (ie, daily living, outside clinical or laboratory settings), 17 18 a more granular picture is required.…”