Abstract
Background: Gait changes occur during all Parkinson’s disease (PD) stages and wearable sensor-derived gait parameters may quantify PD progression. However, key aspects that may qualify quantitative gait parameters as progression markers in PD remain elusive.Objectives: Longitudinal changes in gait parameters from a lower-back sensor under convenient and challenging walking conditions in early- and mid-stage PD patients (E-PD, M-PD) compared to controls were investigated.Methods: Normal- and fast-pace parameters (step: number, time, velocity, variability) were assessed every 6 months for up to 5 years in 22 E-PD (<4 years baseline disease duration), 18 M-PD (>5 years) and 24 controls. Parameter trajectories and associations with MDS-UPDRS-III were tested using generalized estimating equations.Results: Normal-pace step number (annual change in E-PD: 2.1%, Time∗Group: p = 0.001) and step time variability (8.5%, p < 0.05) longitudinally increased in E-PD compared to controls (0.7%, -12%). For fast pace, no significant progression differences between groups were observed. Longitudinal changes in M-PD did not differ significantly from controls. MDS-UPDRS-III was largely associated with normal-pace parameters in M-PD.Conclusion: Wearables can quantify progressive gait deficits indicated by increasing step number and step time variability in E-PD. In M-PD, and for fast-pace, gait parameters possess limited potential as PD progression markers.
Highlights
Progression markers in Parkinson’s disease (PD) are key to advances in PD prognosis and novel treatment efficacy measures
The present prospective observational study with 6-month intervals over a period of up to 5 years investigated the potential of quantitative gait parameters for the assessment of changes in normal- and fast-pace gait, respectively, in early- and mid-stage PD patients
Changes were significantly larger in E-PD (2.1%/year) than in healthy controls (HC) (0.7%/year), and, importantly, showed linear progression over the 5-year observation period
Summary
Progression markers in Parkinson’s disease (PD) are key to advances in PD prognosis and novel treatment efficacy measures. Stopwatch-based motor performance measures have been suggested as progression markers, “turning pegs” and “inserting pegs” in functional dexterity/pegboard tests as measures of upper extremity brady- and hypokinesia (Haaxma et al, 2010). These timed measures have been shown to worsen significantly in early-stage (E-PD) but not mid-stage PD (M-PD) patients over 4 years compared to controls (Heinzel et al, 2017). Objectives: Longitudinal changes in gait parameters from a lower-back sensor under convenient and challenging walking conditions in early- and mid-stage PD patients (E-PD, M-PD) compared to controls were investigated. In M-PD, and for fast-pace, gait parameters possess limited potential as PD progression markers
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