title: Pharmacological treatment in Parkinson's disease: Effects on gait.
abstract: Gait impairments are a hallmark of Parkinson's disease (PD), both as early symptom and an important cause of disability later in the disease course. Although levodopa has been shown to improve gait speed and step length, the effect of dopamine replacement therapy on other aspects of gait is less well understood. In fact, falls are not reduced and some aspects of postural instability during gait are unresponsive to dopaminergic treatment. Moreover, many medications other than dopaminergic agents, can benefit or impair gait in people with PD. We review the effects of pharmacological interventions used in PD on gait, discriminating, whenever possible, among effects on four components of everyday mobility: straight walking, gait initiation, turning, gait adaptability. Additionally, we summarize the effects on freezing of gait. There is substantial evidence for improvement of spatial characteristics of simple, straight-ahead gait with levodopa and levodopa-enhancing drugs. Recent work suggests that drugs aiming to enhance the acetylcholine system might improve gait stability measures. There is a lack of well-designed studies to evaluate effects on more complex, but highly relevant walking abilities such as turning and making flexible adjustments to gait. Finally, paucity in the literature exists on detrimental effects of drugs used in PD that are known to worsen gait and postural stability in the elderly population.
authors.affiliation: Oregon Health & Science University, Department of Neurology, 3181 SW Sam Jackson Park Road, Portland, OR, 97239, United States. Electronic address: katrijn.smulders@gmail.com.
authors.forename: Katrijn
authors.initials: K
authors.lastname: Smulders
authors.affiliation: Oregon Health & Science University, Department of Neurology, 3181 SW Sam Jackson Park Road, Portland, OR, 97239, United States.
authors.forename: Marian L
authors.initials: ML
authors.lastname: Dale
authors.affiliation: Oregon Health & Science University, Department of Neurology, 3181 SW Sam Jackson Park Road, Portland, OR, 97239, United States.
authors.forename: Patricia
authors.initials: P
authors.lastname: Carlson-Kuhta
authors.affiliation: Oregon Health & Science University, Department of Neurology, 3181 SW Sam Jackson Park Road, Portland, OR, 97239, United States.
authors.forename: John G
authors.initials: JG
authors.lastname: Nutt
authors.affiliation: Oregon Health & Science University, Department of Neurology, 3181 SW Sam Jackson Park Road, Portland, OR, 97239, United States; VA Portland Health Care Systems, Department of Research, 3710 SW US Veteran Hospital Road, Portland, OR, 97230, United States.
authors.forename: Fay B
authors.initials: FB
authors.lastname: Horak
mesh_terms: D000058:Accidental Falls / Q000517:prevention & control; D000109:Acetylcholine / Q000378:metabolism; D000978:Antiparkinson Agents / Q000627:therapeutic use*; D015259:Dopamine Agents / Q000627:therapeutic use; D020233:Gait Disorders, Neurologic / Q000188:drug therapy* / Q000209:etiology*; D006801:Humans; D010300:Parkinson Disease / Q000150:complications* / Q000188:drug therapy*; D004856:Postural Balance / Q000187:drug effects
chemical_list: D000978:Antiparkinson Agents; D015259:Dopamine Agents; D000109:Acetylcholine
keywords: Acetylcholine; Dopamine; Falls; Gait; Turning