Characterization of gait variability in multiple system atrophy and Parkinson\u2019s disease

Victoria Sidoroff,Gregor Wenning,Werner Poewe,Jochen Klucken,Oliver Schorr,Stefan Kiechl,Alessandra Fanciulli,Philipp Mahlknecht,Heike Stockner,Christine Kaindlstorfer,Johann Willeit,Kathrin Marini,Heiko Gaßner,Cecilia Raccagni,Klaus Seppi,Gregorio Rungger,Roberta Granata,Björn Eskofier,Sabine Eschlboeck

doi:10.1007/s00415-020-10355-y

Abstract

BackgroundGait impairment is a pivotal feature of parkinsonian syndromes and increased gait variability is associated with postural instability and a higher risk of falls.ObjectivesWe compared gait variability at different walking velocities between and within groups of patients with Parkinson-variant multiple system atrophy, idiopathic Parkinson’s disease, and a control group of older adults.MethodsGait metrics were recorded in 11 multiple system atrophy, 12 Parkinson’s disease patients, and 18 controls using sensor-based gait analysis. Gait variability was analyzed for stride, swing and stance time, stride length and gait velocity. Values were compared between and within the groups at self-paced comfortable, fast and slow walking speed.ResultsMultiple system atrophy patients displayed higher gait variability except for stride time at all velocities compared with controls, while Parkinson’s patients did not. Compared with Parkinson’s disease, multiple system atrophy patients displayed higher variability of swing time, stride length and gait velocity at comfortable speed and at slow speed for swing and stance time, stride length and gait velocity (all P < 0.05). Stride time variability was significantly higher in slow compared to comfortable walking in patients with multiple system atrophy (P = 0.014). Variability parameters significantly correlated with the postural instability/gait difficulty subscore in both disease groups. Conversely, significant correlations between variability parameters and MDS-UPDRS III score was observed only for multiple system atrophy patients.ConclusionThis analysis suggests that gait variability parameters reflect the major axial impairment and postural instability displayed by multiple system atrophy patients compared with Parkinson’s disease patients and controls.

Highlights

Gait impairment, reduced mobility and falls are axial motor complications of parkinsonian disorders, more pronounced and less responsive to treatment in patientsVictoria Sidoroff and Cecilia Raccagni contributed to the manuscript
The sensor-based gait analysis system automatically recognized strides for each cohort in each walking condition and stride count changed with gait speed modulation within the cohorts: comfortable speed—MSA 32, Parkinson’s disease (PD) 27, CG 25 strides, fast speed—MSA 30, PD 22, CG 19 strides, and slow speed—MSA 39, PD 27, CG 26 strides
One key finding of the present work is that multiple system atrophy (MSA-P) patients display higher Gait variability (GV) than PD patients and controls and these differences are more distinct in slow speed, compared to comfortable or fast speed

Summary

Introduction

Gait impairment, reduced mobility and falls are axial motor complications of parkinsonian disorders, more pronounced and less responsive to treatment in patientsVictoria Sidoroff and Cecilia Raccagni contributed to the manuscript. Objectives We compared gait variability at different walking velocities between and within groups of patients with Parkinsonvariant multiple system atrophy, idiopathic Parkinson’s disease, and a control group of older adults. Results Multiple system atrophy patients displayed higher gait variability except for stride time at all velocities compared with controls, while Parkinson’s patients did not. Compared with Parkinson’s disease, multiple system atrophy patients displayed higher variability of swing time, stride length and gait velocity at comfortable speed and at slow speed for swing and stance time, stride length and gait velocity (all P < 0.05). Stride time variability was significantly higher in slow compared to comfortable walking in patients with multiple system atrophy (P = 0.014). Conclusion This analysis suggests that gait variability parameters reflect the major axial impairment and postural instability displayed by multiple system atrophy patients compared with Parkinson’s disease patients and controls

Methods

Results

Discussion

Conclusion