title: Gait disorders and balance disturbances in Parkinson's disease: clinical update and pathophysiology.
abstract: OBJECTIVE
  Gait disorders and balance impairments are one of the most incapacitating symptoms of Parkinson's disease. Here, we discuss the latest findings regarding epidemiology, assessment, pathophysiology and treatment of gait and balance impairments in Parkinson's disease.
  
  
  RESULTS
  Recent studies have confirmed the high rate and high risk of falls of patients with Parkinson's disease. Therefore, it is crucial to detect patients who are at risk of falling and how to prevent falls. Several studies have shown that multiple balance tests improve the prediction of falls in Parkinson's disease. Difficulty turning may be caused by axial rigidity, affected interlimb coordination and asymmetries. Turning difficulties are easily assessed by timed performance and the number of steps during a turn. Impaired sensorimotor integration, inability of switching between sensory modalities and lack of compensatory stepping may all contribute to the high incidence of falls in patients with Parkinson's disease. Similarly, various studies highlighted that pharmacotherapy, neurosurgery and physiotherapy may adversely affect balance and gait in Parkinson's disease.
  
  
  CONCLUSIONS
  Insights into the pathophysiology of Parkinson's disease continue to grow. At the same time, it is becoming clear that some patients may in fact deteriorate with treatment. Future research should focus on the development and evaluation of multifactorial fall prevention strategies.
authors.affiliation: Department of Neurology, Donders Center for Neuroscience, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands.
authors.forename: Tjitske A
authors.initials: TA
authors.lastname: Boonstra
authors.forename: Herman
authors.initials: H
authors.lastname: van der Kooij
authors.forename: Marten
authors.initials: M
authors.lastname: Munneke
authors.forename: Bastiaan R
authors.initials: BR
authors.lastname: Bloem
mesh_terms: D000058:Accidental Falls / Q000517:prevention & control; D020233:Gait Disorders, Neurologic / Q000150:complications* / Q000503:physiopathology / Q000628:therapy; D006801:Humans; D010300:Parkinson Disease / Q000150:complications* / Q000503:physiopathology / Q000628:therapy; D004856:Postural Balance