Gait and balance in Parkinson's disease subtypes: objective measures and classification considerations
Gait and balance in Parkinson's disease subtypes: objective measures and classification considerations
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DOI：
10.1007/s00415-014-7513-6
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发表时间：
2014-12-01
影响因子：
6
通讯作者：
Hausdorff, Jeffrey M.
中科院分区：
文献类型：
--
作者：
Herman, Talia;Weiss, Aner;Hausdorff, Jeffrey M.
帕金森病（PD）常分为震颤显性（TD）和姿势不稳定步态困难（PIGD）亚型。然而，步态的客观测量（例如，步幅、可变性）和平衡在这些亚型中尚未得到很好的研究。为了更好地了解这些运动亚型，我们客观地量化了步态和平衡及其行为相关性。110例PD患者接受了临床评价，并分为PIGD和TD亚型。参与者在单任务和双任务条件下行走，同时佩戴单个身体固定传感器，“关闭”和“打开”药物，并在家3天。我们还检查了基于性能的移动性，平衡和跌倒风险测试。还采用了更严格的标准，将受试者分为主要代表性亚组：p-PIGD和p-TD。PIGD（n = 62）和TD（n = 42）组以及p-PIGD（n = 31）和p-TD（n = 32）亚组在基本疾病特征（例如，病程P > 0.69）。令人惊讶的是，PIGD组和TD组之间的步态速度、步长和变异性没有差异（p > 0.05）。相比之下，p-PIGD组步态速度降低（在单任务和双任务条件下），步幅缩短，步幅变异性增加，步幅规律性降低（规律性：p-PIGD 0.66 +/- A 0.10; p-TD 0.74 +/- A 0.08; p = 0.003）。与p-TD相比，p-PIGD组在基于性能的测试中得分也更差。在PIGD亚型患者中观察到的障碍的临床评估与客观测量不一致;在步态和平衡的许多客观特征中观察到组间重叠。这些研究结果表明，拟议的替代分类方案可能是有用的。
Parkinson's disease (PD) is often divided into tremor dominant (TD) and postural instability gait difficulty (PIGD) subtypes. However, objective measures of gait (e.g., stride length, variability) and balance have not been well studied in these subtypes. To better understand these motor subtypes, we objectively quantified gait and balance and their behavioral correlates. 110 patients with PD underwent a clinical evaluation and were stratified into PIGD and TD subtypes. Participants walked under single and dual task conditions while wearing a single body-fixed sensor, both "OFF" and "ON" medications and at home for 3 days. We also examined performance-based tests of mobility, balance, and fall risk. Stricter criteria were also applied, dividing the subjects into predominant representative subgroups: p-PIGD and p-TD. Both the PIGD (n = 62) and TD (n = 42) groups and the p-PIGD (n = 31) and p-TD (n = 32) subgroups were similar with respect to basic disease characteristics (e.g., disease duration, p > 0.69). Surprisingly gait speed, stride length, and variability did not differ between the PIGD and TD groups (p > 0.05). In contrast, the p-PIGD group had reduced gait speed (under single and dual task conditions), shorter strides, increased stride variability, and decreased stride regularity (regularity: p-PIGD 0.66 +/- A 0.10; p-TD 0.74 +/- A 0.08; p = 0.003). The p-PIGD group also scored worse on performance-based tests, compared to the p-TD. Clinical assessments of the disturbances seen in patients with the PIGD subtype are not consistent with objective measures; overlapping between the groups is seen in many objective features of gait and balance. These findings suggest that the proposed alternate classification scheme may be useful.